REI

Question 1

Infectious contraindications to oocyte donation

Answer 1

Chlamydia or gonorrhea in the last 12 months
Hepatitis B, C
Treponemal positive syphilis
HIV

Question 2

HSG with bilateral hydrosalpinx, management of infertility

Answer 2

bilateral salpingectomy then IVF

Question 3

XY
Breasts (testosterone –> estradiol at puberty), no uterus
Tanner 1 pubic/axillary hair
Male testosterone level

Answer 3

Androgen insensitivity syndrome

Question 4

46XX
Breasts, no uterus
Normal pubic/axillary hair
Normal female testosterone level

Answer 4

Mullerian agenesis

Question 5

46XY
Uterus is present, no breast development
Delayed puberty
No gonads

Answer 5

Swyer syndrome

Question 6

45X
Uterus is present, minimal breast development
No gonads, delayed puberty
Puberty can happen with mosaicism (45X/46XX)

Answer 6

Turner syndrome

Question 7

Ejaculate is propelled into the bladder and the bladder neck fails to contract

Answer 7

Retrograde ejaculation

Question 8

Treatment for retrograde ejaculation

Answer 8

Sympathomimetic agents (psuedoephedrine)
+/- parasympatholytic agents (imipramine)
To stimulate contraction of the bladder neck

Question 9

Infertility management for insufficient sperm in the antegrade ejaculate

Answer 9

Retrograde sperm for IUI

Question 10

How to collect sperm for retrograde IUI

Answer 10

Voided or cath sample
Alkalinize urine with oral acetazolamide, sodium carbonate, or potassium citrate
OR instill bladder with culture media, ejaculate, then void or cath specimen

Question 11

Which treatment of pituitary adenoma is preferred in pregnancy?

Answer 11

Bromocriptine (both are safe, there’s just more data)

Question 12

Patients that have better success after IVF with frozen embryo than fresh

Answer 12

PCOS

Question 13

How do the rates of IVF with frozen vs fresh embryo differ (in patients without PCOS)

Answer 13

They’re similar

Question 14

Most effective medical treatment of pituitary adenoma

Answer 14

Cabergoline

Question 15

Testosterone and DHEAS values that are concerning for ovarian or adrenal tumor in premenopausal women

Answer 15

Testosterone >200

DHEAS >700

Question 16

Severe form of PCOS
Overproduction of androgens by ovarian stromal cells
Progressive hirsuitism/hyperandrogenism after menopause
Treated with bilateral oophorectomy

Answer 16

Ovarian hyperthecosis

Question 17

Contraceptive method shown to decrease the risk of ovarian cancer

Answer 17

Combined OCPs

Question 18

Infertility management for endometriomas under 3cm

Answer 18

IVF

Question 19

Preferred hormonal birth control in patients after bariatric surgery

Answer 19

IUD
Combined estrogen/progestin vaginal ring]
(OCPs may have worse absorption but better than nothing)

Question 20

Most common cause of hyperandrogenism during pregnancy

Answer 20

Hyperreactio luteinalis
Bilateral cystic masses of the ovaries
Multiple gestation, GTN, CKD (reduced clearance of hcg)

Question 21

Pathologic mechanism by which PID predisposes to ectopic pregnancy

Answer 21

Infection results in a loss of ciliated epithelial cells –> impaired intratubal transport of an embryo

Question 22

The physiologic event that induces completion of the first meiotic division of the oocyte is the:

Answer 22

midcycle LH surge

Question 23

LH surge causes:

Answer 23

1. First meiotic division and creation of metaphase II oocyte
2. Granulosa cells and outer theca cells start to favor progesterone over estrogen
3. Progesterone receptor expression increases
4. Follicle rupture and extrusion of the oocyte in 24-36 hours

Question 24

When does second meiotic division of the oocyte take place?

Answer 24

Fertilization

Question 25

Treatment of asymptomatic labial adhesions in prepuberty

Answer 25

Observation (spontaneously resolve with estrogen in puberty)

Question 26

Treatment of symptomatic labial adhesions in prepuberty

Answer 26

Estrogen cream 1-2x per day for 2-6 weeks

Question 27

Female sexual interest/arousal disorder diagnostic criteria

Answer 27

Must have 3 of 6 present for 6 months 1. Absent or reduced interest in sexual activity 2. Absent or reduced sexual thoughts or fantasies 3. No or reduced initiation of sexual activity and seldom receptive to partner's attempts 4. Absent or reduced sexual excitement in sexual encounters 5. Absent or reduced sexual interest/arousal to external cutes 6. Absent or reduced genital or nongenital sensations during sexual activity

Question 28

Most effective therapy for smoking cessation

Answer 28

Behavioral modification counseling

Question 29

Stats table

Answer 29

``` DZ + DZ - T + a b E S - c d T ```

Question 30

Sensitivity

Answer 30

a / (a + c)

Question 31

Specificity

Answer 31

d / (b+d)

Question 32

Risk associated with ICSI

Answer 32

Imprinting disorders | Monozygotic twinning

Question 33

Cortisol in anorexia

Answer 33

Increased

Question 34

Main reason to diagnose an manage central precocious puberty

Answer 34

To achieve appropriate adult height (concern for accelerated bone growth and closure of epiphyseal plates)

Question 35

Size cutoff for following up on simple cyst in premenopausal patient

Answer 35

10cm

Question 36

When should sperm sample be collected

Answer 36

72 hours of abstinence

Question 37

WHO lower reference limits (5%ile) for sperm analysis

Answer 37

``` 15million sperm per mL 39 million sperm per ejaculate 32% progressive motility 40% total motility 4% normal morphology 58% vitality 1.5mL of ejaculate ```

Question 38

When to freeze oocytes in transgender patients

Answer 38

Prior to initiation of testosterone therapy

Question 39

Stem cells that are used to treat Asherman syndrome are derived from

Answer 39

Bone marrow

Question 40

Patient with PCOS and worsening hirsutism, lab test includes testosterone and

Answer 40

DHEAS

Question 41

Can delay gonadectomy until after puberty

Answer 41

Androgen insensitivity syndrome

Question 42

Gonadectomy in patients with 45X/46XY karyotype

Answer 42

Immediately (risk of gonadoblastoma)

Question 43

Risk factors for opioid addiction

Answer 43

Younger age Certain types of illicit drug use Tobacco use Psychiatric comorbidities (depression, etc)

Question 44

Tests to perform with premature thelarche

Answer 44

Bone age | FSH, LH, estradiol

Question 45

Ovulation induction in patients with hypogonadotropic hypogonadism

Answer 45

Urinary human menopausal gonadotropins

Question 46

Why can't anonymous sperm donors stay completely anonymous?

Answer 46

Direct-to-consumer genetic testing

Question 47

Nonhormonal options for vasomotor symptoms

Answer 47

SSRI Clonidine Gabapentin

Question 48

single catastrophic event that results in extensive locally clustered genomic rearrangements and an oscillating pattern of DNA copy number levels, all curiously restricted to one or a few chromosomes

Answer 48

Chromothripsis | how fibroids happen

Question 49

Must evaluate before attempting pregnancy with donor eggs

Answer 49

Uterine cavity (HSG, sonohysterography, etc)

Question 50

Most common chromosomal abnormality causing azospermia

Answer 50

47XXY

Question 51

Tubal ligation risk of regret age cutoff that was studied

Answer 51

30

Question 52

Uterine artery embolization for fibriods causes highest risk of

Answer 52

``` Miscarriage Preterm delivery Malpresentation Postpartum hemorrhage (Myomectomy has higher risk of uterine rupture) ```

Question 53

Fecundability rate in one year

Answer 53

90%

Question 54

How many weeks after fertilization does neural tube form

Answer 54

3-4

Question 55

Fecundity declines significantly at what age

Answer 55

32

Question 56

What days of menstrual cycle constitutes window of implantation of the human embryo

Answer 56

20-24

Question 57

Side effects of spironolactone

Answer 57

Vomiting PMB Dizziness Mastalgia

Question 58

What muscle overlies the sacrospinous ligament

Answer 58

Coccygeus

Question 59

Main support to the vagina

Answer 59

Uterosacral ligament