ABOG study

Question 1

what are the 3 possible definitions for primary amenorrhea?

Answer 1

No menses by:
1) age 15 w normal 2ndry sexual characteristics
2) within 5 years after breast development if that occurs before age 10
3) by age 13 with no 2ndry sexual characteristics

Question 2

when doing progestin challenge, within how many days should bleeding occur after completion of progestin course?

Answer 2

2-7 days

note: this has high false positive (40-50%) and false negative (20%) rates

Question 3

estradiol levels can fluctuate greatly so there’s no specific cutoff but in general greater than what level suggests ovarian follicular activity (for example when working up amenorrhea)

Answer 3

> 40 pg/mL

dont forget, ultrasound eval with endometrial thickness of at least 2 layer stripe also indicates they have sufficient estrogen.

Question 4

what FSH level strongly indicates hypogonoadotropic hypogonadism?

Answer 4

<5 IU/L

Question 5

what FSH level strongly indicates ovarian failure? (hypergonadotropic hypogonadism)

Answer 5

> 20IU/L

Question 6

in workup of amenorrhea, what does a normal FSH and estradiol indicate?

Answer 6

normal hypothalamus and pituitary function. cause of amenorrhea is due to anovulation or anatomic defects (in 2ndry amenorrhea this would be like asherman syndrome)

Question 7

cessation of menses before what age is considered primary ovarian insufficiency?

Answer 7

40 years old

Question 8

chromosomal abnormalities will almost always result in POI before age 30. list the two possibilities (hint: not fragile x)

Answer 8

1) x and y chroosome mosaicism (note, if Y chromosome present, gonads should be removed due to risk for malignant transformation)
2) x chromosome structural abnormalities (deletions, translocations)

Question 9

The fragile X gene FMR1 abnormal expansion of the ____ repeat on long arm of X chromosome, with greater than ____ repeats causes full syndrome, and ___ - ____ repeats causes premutation.

Answer 9

CGG
>200 full syndrome
55-200 premutation

Question 10

autoimmune cause of POI can be from adrenal or thyroid disease. which antibodies for these should be tested?

Answer 10

adrenal: 21-hydroxlse antibodies (anti-CYP21)

thyroid: thyroid peroxidase, anti-thyroglobulin

Question 11

which type of chemo drugs is most toxic to ovaries? (2)

Answer 11

alkylating agents (cyclophosphamide, cisplatin) and procarbazine

Question 12

amenorrhea or delayed puberty/sexual development but normal pubic hair, and anosmia is ______ syndrome

Answer 12

Kallmann syndrome

Question 13

what are the 3 main features of McCune-Albright syndrome (aka, Polyostotic Fibrous Dysplasia) ? and what is the pathologic mechanism? (mutation in _____)

Answer 13

1. multiple disseminated cystic bone lesions that easily fracture
2. cafe au lait skin spots
3. precocious puberty

bonus: other features: ovarian cysts, growth hormone and prolactin adenomas, hyperthyroidism, hypercortisolism, osteomalacia

mechanism: mutation in the alpha subunit of a G protein

Question 14

what is the most common cause of precucious puberty onset AFTER 4 years of age?

Answer 14

idiopathic

Question 15

what is the most common cause of precocious puberty onset BEFORE 4 years of age?

Answer 15

CNS lesion

Question 16

what is the most common cause of delayed puberty?

Answer 16

ovarian failure. specifically, gonadal dysgenesis (Turner syndrome, Swyer’s syndrome).

Question 17

what imaging modality should be used to evaluate renal system in someone who has mullerian anomalies?

Answer 17

CT urogram or renal ultraosund

Question 18

ultraound findings diagnostic of pregnancy failure:

1) CRL of ___mm or greater and no heart beat.

2) mean sac diameter of _____mm and no _____

3) absence of EMBRYO W HEARTBEAT, _____ or more after ultrasound that showed ________

4) abscence of embryo WITH HEART BEAT _____ or more after US that showed _________

Answer 18

1) 7mm CRL and no heartbeat

2) 25mm sac diameter and no embryo

3)absence of EMBRYO W HEARTBEAT, 2 weeks after scan that showed gestational sac WITHOUT a yolk sac aka empty gestational sac

4) abscence of embryo WITH HEART BEAT 11 days or more after US that showed gest sac WITH yolk sac

Question 19

criteria for APLS diagnosis:

Answer 19

clinical:

lab:

Question 20

failure to lactate within 7 days after delivery may be the first sign of what syndrome?

Answer 20

sheehan’s syndrome

Question 21

relative vs absolute contraindications for MTX

Question 22

testes determining factor AKA SRY gene is located where?

Answer 22

distal short arm of the Y chromosome

Question 23

what is hereditary pattern/gene of AIS?

Answer 23

X-linked recessive
(mutation in androgen receptor gene)

Question 24

what is hereditary pattern/gene of 5alpha reductase defic?

Answer 24

autosomal recessive

Question 25

what is most common gonadal tumor to occur in people with 46 XY with female phenotype?

Answer 25

gonadoblastoma (can also have dysgerminomas and embryonal carcinomas)

Question 26

mechanism of clomiphene vs letrozole

Answer 26

clomiphene: letrizole:

Question 27

prevalence of endometriosis in general population of reproductive age is 6-10%. what's the prevalence in infertile women? in chronic pelvic pain?

Answer 27

infertility: 38% (20-50%) CPP: 71-87%

Question 28

which inherited thrombophilia testing is affected by pregnancy?

Answer 28

Protein S deficiency

Question 29

first line treatment and alternatives (2) for chlamydia

Answer 29

1st line: doxy 100mg bid x7 days alternatives: azithromycin 1000mg single dose, or levofloxacin 500mg qd x7days

Question 30

first line treatment and alternatives (1) for gonorrhea

Answer 30

1st line: ceftriaxone. 500mg IM if <150kg. 1000mg if =>150kg alternatives: Gentamycin 240mg IM PLUS Azithromycin 2g

Question 31

if someone has genital ulcer what 3 stds should you test for?

Answer 31

syphilis, HSV, HIV

Question 32

prophylaxis after rape includes rocephin x1, doxy and flagyl x7 days, and offer what other 4 things?

Answer 32

1. offer hep B vaccine initial dose 2. offer HIV 28 day PEP 3. offer HPV vaccine ages 9-26 4. tetanus booster

Question 33

redose cephazolin intraop at ____ hours, and if >= ______ml blood loss

Answer 33

4 hours 1500ml

Question 34

average age of diagnosis of interstitial cystitis?

Answer 34

40 yrs old

Question 35

what med can help food related exacerbation of interstitial cystitis?

Answer 35

calcium glycerophosphate (prelief)

Question 36

what is embryologic origin of primary oocytes?

Answer 36

yolk sac

Question 37

when does meiosis I occur?

Answer 37

starts in utero arrests in prophase until that egg is selected for ovulation. becomes 23x from 46 xx

Question 38

when does meiosis II occur?

Answer 38

when selected for ovulation, goes from prophase I then arrests in metaphase II until fertilization. becomes mature oocyte +2nd polar body. still 23x

Question 39

after fertilization, the zygote undergoes ______ to multiply after which it becomes a Morula (16-32 cells)

Answer 39

cleavage

Question 40

what phase is the developing embryo in when impantation occurs?

Answer 40

blastocyst (morula day 4, then starts to accumulate fluid called blastocoel, together= blastocyst)

Question 41

what does urogenital sinus give rise to (4)?

Answer 41

1. urethra 2. bladder 3. distal 2/3 of vagina 4. skenes and bartholins glands

Question 42

what is embryologic origin of penis (2)

Answer 42

phallus and urogenital folds

Question 43

what is embryologic origin of uterus and fallopian tubes?

Answer 43

paramesonephric duct

Question 44

what is embryologic origin of labia? (2)

Answer 44

labia minora- urogenital folds labium majora- labioscrotal swellings

Question 45

what is embryologic origin of hymen?

Answer 45

mullerian tubercle

Question 46

what are the 3 shunts in fetal circulation?

Answer 46

1. ductus arteriosis- right atrium to left atrium (bypass lung) 2. foramen ovale- pulmonary artery to aorta (bypass lung) 3. ductus venosus- come off of umbilical vein , bypass liver, go to vena cava

Question 47

lithium is associated with what fetal anomaly?

Answer 47

Ebstein anomaly (downward displacement of tricuspid valve)

Question 48

thalodimide is associated with what fetal anomaly?

Answer 48

limb abnormalities

Question 49

warfarin is associated with what fetal anomaly?

Answer 49

nasal and mid-facial hypoplasia, stippled femoral and vertebral epiphysis

Question 51

for mono-di twins, how many days after fertilization did egg undergo cleavage?

Answer 51

4-8 days

Question 52

schiller-duval bodies (invaginated papillary structures with a central vessel) are associated with what type of tumor?

Answer 52

yolk sac tumor

Question 53

3 branches of posterior internal iliac artery?

Answer 53

ILS: Iliolumbar (travels upwards toward spine) Lateral sacral artery superior gluteal (actually travels down ish. towards glutes)

Question 54

3 branches of external iliac

Answer 54

inferior epigastric artery deep circumflex iliac artery femoral artery

Question 55

what histological finding in clear cell carcinoma?

Answer 55

hobnail cells (bulbous nuclei that protrude into lumen at cytoplasmic limits of the cell)

Question 56

what histological finding in granulosa cell tumor?

Answer 56

Call-Exner bodies (giving a follicle-like appearance, are small eosinophilic fluid-filled punched out spaces between granulosa cells)

Question 57

what histological finding in papillary serous carcinoma?

Answer 57

psammoma bodies (round, calcium phosphate spherules that look like hardened concentric rings)

Question 58

which germ cell tumor has solely elevated AFP?

Answer 58

endodermal sinus tumor

Question 59

which germ cell tumor has elevated AFP and B hcg?

Answer 59

embryonal carcinoma

Question 60

what is treatment for toxoplasmosis?

Answer 60

Pyrimethamine and sulfadiazine

Question 61

neonatal mortality rate for severe neonatal varicella and whats delivery time frame this is highest risk for

Answer 61

4-5 days before to 2 days after mom gets it 20% mortality rate

Question 62

most common antigen involved in NAIT (fetal-neonatal alloimmune thrombocytopenia)?

Answer 62

HPA-1a

Question 63

cytoplasmic glycogen demonstrated with periodic acid-Schiff stain is pathognomonic for what type of tumor?

Answer 63

dysgerminoma

Question 64

which ovarian neoplasm has elevated inhibin and CA 125?

Answer 64

granulosa cell tumor (obvis estrogen also elevated but you dont normally get that with tumor markers)

Question 65

if patient is taking _____, this is a contraindication to taking paroxetine (FDA approved for vasomotor menopausal symptoms)

Answer 65

tamoxifen

Question 66

what chromosome is brca 1 and brca 2 located on (they are different)

Answer 66

brca 1 = chromosome 17 brca2 = chromosome 13

Question 67

what 2 drugs are FDA approved for vasomotor menopausal symptoms besides HRT?

Answer 67

fenolizetant paroxetine

Question 68

overlapping fingers and rocker bottom feet are features of _____ syndrome

Answer 68

edwards syndrome

Question 69

polydactyly (extra fingers) and microcephaly and cleft lpalate and absent eyebrows are signs of ____ syndrome

Answer 69

patau (T13)