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COMLEX > Repro > Flashcards

Repro Flashcards

1
Q

Pt had D&C, has not had menses since, what should be high on differential?

A

Asherman syndrome

- scraped off stratum basalis, leaving endometrium inadequate for implantation (too much scar tissue/adhesions)

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2
Q

deficiency in mineralocorticoids (aldosterone)

  • hyponatremia, hyperkalemia, HYPOtension
  • ambiguous genitalia d/t overproduction of androgens
A

21-b-hydroxylase deficiency (MCC CAH)

- hypotension activates RAAS

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3
Q

overproduction of mineralocorticoids with decreased levels of glucocorticoids and gonadal steroids
- HTN, hypokalemia

A

17-a-hydroxylase def

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4
Q

placenta adheres to surface of the myometrium, rather than decidua of uterus

A

placenta accreta

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5
Q

chorionic villi penetrate through the myometrium, to the uterine serosa or adjacent organs

A

placenta percreta

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6
Q

chorionic vili penetrate into myometrium

A

placenta increta

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7
Q

lutenized follicle cysts within the ovary
- woman presenting with unilateral or bilateral cystic adnexal masses with a history of recent pregnancy, known gestational trophoblastic disease, multiple gestations, ovarian hyperstimulation, or a pregnancy complicated by fetal hydrops

A

theca lutein cyst

- form as a result of overstimulation from high levels of hCG

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8
Q
  1. ovarian fibroma (proliferating spindle-shaped fibroblasts)
  2. ascites
  3. pleural effusion
A

Meigs syndrome

- removal of the fibroma results in elimination of ascites and pleural effusion

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9
Q

women in 30-40’s, pelvic pressure, pain, menorrhagia, and dysmenorrhea

  • MC tumor in females
  • appear as calcified lesions on xray
A

leiomyoma

  • benign neoplasm of smooth muscle
  • can cause spontaneous abortion and infertility
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10
Q

persistent scaling, eczematous eruption, or ulcerating lesion involving the nipple and areolar complex
- nipple may appear scaly or crusted, raw, vesicular, or ulcerated

A

Paget disease of breast

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11
Q

Paget disease of breast is a risk factor for what malignancy?

A

invasive ductal carcinoma

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12
Q

rapid onset and presents as red, warm, edematous skin that resembles inflammation
- thickening and dimpling of the skin that resembles an orange peel (peau d’orange)

A

inflammatory breast carcinoma

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13
Q

bloody nipple discharge without a palpable mass

A

intraductal papilloma

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14
Q

do aldosterone levels increase or decrease in pregnancy?

A

increase

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15
Q

does GFR increase or decrease in pregnancy?

A

increase

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16
Q

does systemic vascular resistance increase or decrease in pregnancy?

A

decrease

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17
Q

does tidal volume increase or decrease in pregnancy?

A

increase

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18
Q

does expiratory reserve volume increase or decrease in pregnancy?

A

decrease

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19
Q

does thyroid binding globulin increase or decrease in pregnancy?

A

increase

  • bound T3/T4 increases
  • free thyroxine (T4) remains the same
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20
Q

rare ovarian tumor containing ectopic thyroid tissue as the major cellular component
- nonspecific presenting symptoms that may include a pelvic mass, abdominal pain, ascites, abnormal vaginal bleeding, and hyperthyroidism

A

struma ovarii

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21
Q

what is the most common hormonal elevation seen in PCOS?

A

increase in LH (LH:FSH > 2)
- increase in LH occurs due to pituitary oversecretion and leads to both decreased synthesis of FSH as well as increased androgen production

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22
Q

what produces b-hCG?

A

syncytiotrophoblast of placenta

- also produces progesterone and human placental lactogen (aka human chorionic somatomammotropin) during pregnancy

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23
Q

what adverse effect can metoclopramide have on breast tissue?

A

it is an anti-dopaminergic -> stops inhibition of prolactin -> galactorrhea

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24
Q

male, 15-35 with a firm, nontender testicular mass that does not transilluminate
- precocious puberty, gynecomastia, impotence, or loss of libido

A

choriocarcinoma

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25
Q

solid, lobulated, yellow-tan tumor

  • men of all ages, present with virilization and gynecomastia
  • round nuclei, single prominent nucleoli, and abundant eosinophilic cytoplasm or abundant clear cytoplasm
  • reinke crystals (rod-shaped intracytoplasmic crystal-like inclusions with rounded ends)
  • inhibin alpha is tumor marker
A

leydig cell tumor

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26
Q

occur both in children and in middle-aged adults

  • well-circumscribed and pale yellow to whitish gray in color
  • uniform tall polyhedral cells that are arranged in nests, sheets, and cords resembling spermatic tubules
  • perinuclear aggregates of intermediate filaments
  • inhibin alpha is tumor marker
A

sertoli cell tumor

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27
Q

most common testicular neoplasm in infants and children

  • painless and bulky testicular mass
  • honeycomb pattern
  • *schiller duval bodies (central vessel lined by fibrous tissue and surrounded by malignancy epithelial cells in a cystic space)
  • a-fetoprotein is tumor marker
A

yolk sac tumor

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28
Q

cystic swelling of the chorionic villi and proliferation of trophoblastic tissue, without formation of any fetal tissue or amniotic fluid
- abdominal growth, hCG much higher than normal pregnancy ( >200,000)

A

complete mole

- partial mole will not have as high hCG

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29
Q

what is the dominant estrogen of late pregnancy?

A

estrone

- estradiol is dominant estrogen every other time

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30
Q

X-linked dominant, mutation causes methylation of FMR1 gene

  • leads to CGG trinucleotide repeat
  • mental retardation and autistic-like behaviors
A

fragile X

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31
Q

hyperphagia, early-onset obesity, hypogonadism, developmental delay, and hypotonia

  • small hands and feet, almond shaped eyes
  • paternal deletion on Xsome 15, mom’s copy is imprinted
A

Prader-Wili

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32
Q

lack of embryonic migration of the olfactory bulb cells to the hypothalamus

  • lack of puberty development
  • lack of secondary sex characteristics
  • decreased GnRH, LH, and FSH
  • decreased sense of smell
A

Kallman syndrome
- idiopathic hypogonadotropic hypogonadism that results from a deficiency of a gonadotropin-releasing hormone (GnRH) from the hypothalamus

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33
Q

pain caused by the abnormal implantation of endometrial glandular and stromal tissue within the myometrium
- uniformly enlarged and boggy uterus on physical examination, can be tender

A

adenomyosis
- more common in multiparous women, women over the age of 35, and those with a history of uterine surgeries such as cesarean section

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34
Q

pale, ovoid nucleus, large nucleolus, and a large amount of pale-staining cytoplasm
- what are they called and when would you see them?

A

halo cells

- Paget dz of breast

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35
Q

benign, small tumor that is found beneath the areola

- typically presents as bloody nipple discharge in woman less than 50

A

intraductal papilloma

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36
Q

multiple bilateral malignant breast lesions

- histo shows orderly row of cells, often described as “Indian files.”

A

invasive ductal carcinoma

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37
Q

bilateral ovarian metastases from a gastrointestinal tract adenocarcinoma

  • invasive, mucin-filled, signet ring cancer cells
  • associated with acanthosis nigricans and leser-trelat sign
A

Krukenberg tumor

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38
Q

what dopamine agonist is used to treat galactorrhea by inhibiting prolactin?

A

bromocriptine

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39
Q
  • short stature, web necked, widely spaced nipples
  • streak ovaries (ovarian dysgenesis)
  • infertility d/t primary amenorrhea (low estrogen) -> high LH/FSH
  • horseshoe kidney and bicuspid aorta
A

turner syndrome

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40
Q

male with gynecomastia, erectile dysfunction and decreased libido
- potential galactorrhea

A

prolactinoma
- pituitary adenoma that secretes excess prolactin, which decreases the secretion of GNrH and therefore, lowers LH and FSH

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41
Q

hyperandrogenism, irregular menstrual cycles

  • increased LH and total testosterone, decreased FSH
  • state of hyperinsulinemia and insulin resistance
A

PCOS

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42
Q

LH activates what enzyme in theca cells?

A

desmolase

- produces androstenedione

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43
Q

FSH activates what enzyme in granulosa cells?

A

aromatase

- produces estrogen

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44
Q

where is oxytocin produces?

A

hypothalamus

- released from posterior pituitary (same as ADH)

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45
Q

taking tamoxifen (SERM) after mastectomy increase your chance of what?

A

endometrial carcinoma

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46
Q

tx for endometriosis
- synthetic androgenic steroid that inhibits pituitary secretion of FSH and LH, inhibiting ovulation and ovarian estrogen release

A

danazol

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47
Q

MCC primary amenorrhea

- short stature, horseshoe kidney, coarctation of aorta, Madelung deformity of wrist, conductive hearing loss

A

Turner syndrome

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48
Q

what ligament is almost always involved in ovarian torsion?

A

infundibulopelvic (suspensory ligament of ovary)

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49
Q

what seizure med is known to cause fetal hydantoin syndrome?

- cleft lip, nail hypoplasia, growth and mental retardation, cardiac defects

A

phenytoin

- osteomalacia is a long term side effect for mother, NOT fetus

50
Q

what mood stabilizer is known to cause Ebstein’s anomaly in pregnancy?
- large R atrium, small R ventricle

A

lithium

51
Q

Estrogen promotes healthy bone turnover by inhibiting what?

A

osteoclasts

- after menopause, no more inhibition means too much osteoclast activity

52
Q

when fetal blood vessels cross over internal os and are at risk of a tear?
- causes painful vaginal bleeding

A

vasa previa

53
Q

gestational sac located in the lower uterine area instead of the typical fundal implantation, or close to or within a prior cesarean scar

  1. Loss of placental homogeneity appearing as venous lakes or placental lacunae
  2. Retroplacental myometrial thickness < 1 mm
  3. Disruption of the normally continuous white line between the bladder wall and uterine serosa interface
A

placenta accreta

54
Q

progestin in OCP’s suppresses what?

A

LH release

55
Q

estrogen in OCP’s suppresses what?

A

FSH release

56
Q

genetic male, phenotypic female
- testes develop due to the presence of the SRY gene on the Y chromosome and are often found within the labia, inguinal canal, or intra-abdominally.

A

androgen insensitivity syndrome

57
Q

what drug is a glucocorticoid and progesterone antagonist that competitively binds to the intracellular progesterone receptor to block the effects of progesterone
- it changes the uterine lining and causes detachment of the pregnancy, softening and opening of the cervix, and increasing uterine sensitivity to prostaglandin

A

mifepristone

58
Q

synthetic prostaglandin E1 analog that has been shown to induce uterine contractions
- does not inhibit progestin

A

misoprostol

59
Q

what does thyroid release hormone stimulate other than the thyroid?

A

prolactin release

60
Q

what tanner stage?
- dark, coarse pubic hair that is sparse in distribution and enlargement of the breast, but with no separation of contour

A

stage 3

61
Q

what tanner stage?

- pubic hair that is adult in quality (dark and coarse) but is limited to the pubic area, sparing the thighs

A

stage 4

62
Q

what tanner stage?

- projection of the papilla above the areola and breast mound

A

stage 5 (sexually mature)

63
Q

selective estrogen receptor modulator (SERM)

  • inhibits negative feedback of estrogen in the hypothalamus on gonadotropin release
  • increases release of LH and FSH from the anterior pituitary gland
  • causes ovarian hyperstimulation -> multiple enlarged follicles are stimulated
A

clomiphene

- used to treat infertility in PCOS

64
Q

GnRH analog, administered in continuous fashion to decrease LH and FSH production

A

leuprolide

65
Q

antiandrogen used to decrease testosterone production

- inhibits 5-alpha reductase (thus inhibiting conversion of T -> DHT)

A

finasteride

66
Q

semisynthetic ergot alkaloid and dopamine receptor agonist

- inhibits prolactin secretion

A

bromocriptine

67
Q

persistent elevation of LH levels relative to FSH should immediately make you think of what?

A

PCOS

  • estrogen must reach a certain concentration to trigger an LH surge -> ovulation
  • in PCOS, estrogen levels do not reach the required concentrations -> anovulation
  • excess androgens result in hirsutism, acne, and male pattern balding
68
Q

what is the shortest antero-posterior diameter through which the fetal head must pass?

A

obstetric conjugate

- extends from the sacral promontory to the closest point on the convex posterior surface of the symphysis pubis

69
Q

what is the widest distance between the iliopectineal lines?

A

transverse diameter

70
Q

large, atypical adenocarcinoma cells with pale to clear cytoplasm (clear halos) that infiltrate though the epidermis as either single cells or clusters of cells

A

Paget’s disease of the breast

- look for older woman with nonhealing eczema on the nipple

71
Q

Nodular proliferation of cells extending from the stratum basalis

A

basal cell carcinoma (skin)

72
Q

Stromal overgrowth with compressed glandular structures

A

phyllodes tumor

- fibroepithelial neoplasm of stroma of the breast

73
Q

what is the first line tx for prevention of maternal transmission of HIV?

A

zidovudine and lamivudine

- both NRTI’s that competitively inhibit reverse transcriptase (RNA-dependent DNA polymerase)

74
Q

69 XXY or 69 XXX

  • mildly elevated b-hCG
  • can contian fetal parts (fetal heart tones can be heard early on)
A

partial mole

75
Q

46 XX

  • uterine size enlarged for gestational age
  • significantly elevated beta-hCG (> 100,000 mIU/mL)
  • absence of fetal parts upon ultrasound
A

complete mole

76
Q

what is the earliest phenotypic change seen in puberty?

A

thelarche, aka breast development (average age 10)
- occurs in response to estradiol release from the ovaries

NOTE that adrenarche and gonardarche happen first (age 6-8), but no phenotypic changes can be seen, it is only hormonal

77
Q

genetic males born with ambiguous genitalia

  • may present with a clitoral-like phallus, bifid scrotum, pseudovaginal perineoscrotal hypospadias, and a rudimentary prostate
  • internal genitalia are normal and luteinizing hormone (LH) may be normal or increased
  • when child reaches puberty, testes descend and genitalia become more masculine in appearance
A

5-alpha reductase deficiency

78
Q

most common testicular tumors in young adult males aged 15-35

  • histo shows large cells in lobules with watery cytoplasm and a “fried egg” appearance
  • Cryptorchidism is a known risk factor (for all testicular germ cell tumors)
  • malignant, but metz slowly and respond well to radiation
A

seminoma

79
Q

osteopathic treatment for dysmenorrhea?

A

sacral inhibition

- influences parasympathic activity to pelvic organs

80
Q

chapmans point for ovaries?

A

on the pubic tubercle

81
Q

chapmans point for uterus?

A

b/l sacral base, between L4/5 TP

82
Q

what hormone

  • causes the cervical mucus to become thick
  • raises basal body temperature
  • inhibits both LH and FSH secretion
A

progesterone

- highest during luteal phase

83
Q

what hormone

  • causes the cervical mucus to be thin and watery
  • inhibits FSH secretion
  • stimulates mitosis of the endometrium
A

estrogen

- highest during follicular phase

84
Q

when is the follicular phase?

A

day 1-13

- menses, then proliferative phase

85
Q

when is the luteal phase?

A

day 14-28

- aka secretory phase

86
Q

what hormone is highest during menses, and then is the lowest of all 4 hormones the rest of the month?

A

FSH

87
Q

should be suspected in any pregnant women who experiences vaginal bleeding after 20 weeks, especially when the bleeding is painless
- risk factors include a previous cesarean section, grand multiparity (usually > 5 deliveries), multiple gestation, increased maternal age, infertility treatment, previous surgery to the uterus, and smoking

A

placenta previa

88
Q

high-riding testis with abnormal transverse lie and loss of the cremasteric reflex
- identified by Doppler ultrasound and immediate surgical evaluation

A

testicular torsion

- T10-11 sympathetics

89
Q

Dopamine antagonists are the most common culprits of what?
- antipsychotic medications (FGA MC haloperidol and fluphenazine); SGA (risperidone and paliperidone); and prokinetic agents (metoclopramide).

A

galactorrhea

90
Q

what does GnRH stimulate?

A

FSH, LH

91
Q

OCP’s have a protective effect on what tissue?

A

endometrial and ovarian

- no change to breast tissue, evidence shows increased risk of cervical cancer?

92
Q

leuprolide can be given continuously as a treatment for what?

A

uterine fibroids

  • is a GnRH analog that works as an agonist when given in a pulsatile manner
  • when given continuously, works as an antagonist
93
Q

MOA of sildenafil?

A

inhibits phosphodiesterase-5 causing an increase in cGMP

- relaxes the smooth muscle of the vascular corpora cavernosa

94
Q

lower back pain, vaginal bleeding, and ultrasound findings of a dark crescent-shaped region

A

placental abruption

95
Q

what ligament does the artery of Sampson run through?

A

the round ligament

- connects the uterine fundus with the labia majora, running through the inguinal canal

96
Q

In patients older than 35, what are the 3 MCC (bugs) of epididymitis?

A

Escherichia coli, Pseudomonas, and Proteus

97
Q

In patients younger than 35, what are the 3 MCC of epididymitis?

A

Chlamydia trachomatis and Neisseria gonorrhoeae

98
Q

what is the function of BRCA1?

A

homologous recombination

99
Q

cellulitis of the periglandular tissue caused by nipple trauma from breastfeeding coupled with the introduction of bacteria from the infant’s pharynx into the nipple ducts

A

mastitis

- S. aureus is MCC

100
Q

woman in 50-60’s, malignant ovarian tumor of epithelial origin

  • ingrowths of papillary and glandular structures with stromal invasion
  • psammoma bodies
  • poorly differentiated, often described as solid sheets of cells
A

serous cystadenocarcinoma

101
Q

malignant epithelial tumor

  • multiple loculi lined with mucin-secreting epithelium and stromal invasion
  • pseudomyxoma peritonei
A

mucinous adenocarcinoma

102
Q

metastatic tumor, typically located from the stomach to the ovaries (usually bilateral)

  • filled with mucin
  • signet ring appearance
A

Krukenberg tumor

103
Q
  • Benign ovarian tumor
  • Bilateral in 10%-25% of cases
  • Typically filled with pale yellow or clear serous fluid
  • Treatment is either unilateral salpingo-oophorectomy or ovarian cystectomy
A

serous cystadenoma

104
Q
  • Benign ovarian tumor
  • Filled with mucin, often multiloculated
  • Bilateral in less than 5% of cases
  • Oftentimes very large tumors
A

mucinous cystadenoma

105
Q
  • Typically benign ovarian tumor

- Characterized by transitional (bladder) epithelium with stromal invasion

A

Brenner tumor

106
Q

homogenous, thin, gray/white discharge that is smooth in texture and found to coat the vaginal walls

  • pH > 4.5
  • clue cells
  • whiff test
A

BV -> gardnerella

  • V common in pregnancy
  • treat w/ oral metronidazole
107
Q

green, frothy copious discharge

- cells may appear to have a corkscrew motility

A

trichimonas

- tx w/ oral metronidazole

108
Q

male w/ bitemporal hemianopsia, gynecomastia, erectile dysfunction, infertility

A 
pituitary adenoma (prolactinoma MC)
- hypogonadotropic hypogonadism: prolactin inhibits GnRH -> decreased FSH/LH -> decreased testosterone
109
Q

what hormone is responsible for testosterone production?

A

LH

110
Q

what hormone is responsible for spermatogenesis?

A

FSH

111
Q

folate antagonist that binds to the catalytic site of dihydrofolate reductase
- used to treat ectopic pregnancy

A

methotrexate

112
Q

what is the first line agent for advanced ovarian cancer?

A

paclitaxel

  • binds to beta subunit of tubulin, enhances microtubular stabilization
  • formation of microtubule bundles that interfere with mitosis and cell division
113
Q

genetic condition causing defective luteinizing hormone (LH) receptors on the Leydig cells

  • ca present with hypospadius, micropenis, ambiguous genitalia, cryptorchidism, atrophic testes, bifid scrotum, and/or female external genitalia
  • prostate, seminal vesicles, ductus deferens, and epididymis can be absent
A

Leydig cell hypoplasia

114
Q

what hormone is responsible for the development of the mesonephric ducts?
- giving rise to the seminal vesicles, epididymis, ejaculatory duct, ductus deferens, and part of the prostate gland

A

LH

115
Q

what hormone has structural homology with the TSH-FSH-LH hormone family through the alpha subunit?

A

hCG

  • conditions that carry elevated hCG levels (i.e. testicular cancer) can produce symptoms of other hormones
  • hyperthyroidism (through TSH) and gynecomastia (through LH)
116
Q

male 46XY genotype, but external female phenotype

  • no internal reproductive organs, meaning no uterus or uterine tubes, but instead have a “blind pouch” vagina
  • undescended testes, palpable inguinal masses
  • labs will reveal an increase in testosterone, estrogen, and LH
A

complete androgen insensitivity

117
Q

male phenotype with testicular atrophy and female hair distribution

  • dysgenesis of the seminiferous tubules -> increased FSH
  • abnormal Leydig function -> decreased testosterone, increased LH, increased estrogen
A

Klinefelter syndrome (47XXY)

118
Q

what SERM is used as treatment for osteoporosis?

A

raloxifene

- no increased risk of endometrial cancer (like tamoxifen)

119
Q

teenage female with fully developed secondary sex characteristics (normal ovaries, NL breast development and pubic hair)
- short vagina, variable uterus -> won’t menstruate

A

vaginal agenesis aka Mayer-Rokitansky Kuster Hauser syndrome

120
Q

46XY males who appear phenotypically female

  • no pubic hair or secondary sex characteristics
  • no uterus or ovaries
  • cryptorchid testes
A

androgen insensitivity syndrome

121
Q

primary amenorrhea, no secondary sex characteristics, olfactory sensory defect

A

Kallman syndrome

122
Q

prominent forehead, long narrow face, large ears, prominent chin, macroorchidism

A

fragile X

- small gap on tip of long arm of X xsome (appears broken/fragile)

COMLEX (14 decks)

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