Repro

Question 1

What ligament carries the uterine blood supply?

Ovarian blood vessels?

Answer 1

Cardinal ligament

Suspensory ligament of the ovary

Question 2

How would a radical prostatectomy cause erectile dysfunction?

Answer 2

Cavernous nerves carrying parasympathetics to the penis travel near the prostate and can be damaged during removal

Question 3

Female equivalent of bulbourethral glands (after prostate)

Answer 3

Vestibular (bartholin) glands (dorsal vestibule)

Question 4

Female equivalent of prostate gland

Answer 4

Paraurethra (skene) glands

Question 5

What does the gubernaculum form in the female?

Answer 5

Ovarian ligament (ovary-uterus) + round ligament of the uterus (uterus-labia majora)

Question 6

What reproductive structures would form if Sertoli cell development was disrupted?

Answer 6

Both male and female internal genitalia
No MIF = paramesonephros never regress
Leydig cells still make testosterone = mesonephros develop

Question 7

Why can obese males become testosterone deficient?

Answer 7

More adipocytes = increased amortize activity = depletes normal testosterone production by converting it to estrogen

Question 8

How would exogenous testosterone increase risk for cardiovascular disease?

Answer 8

Increases LDL and decreases HDL

Question 9

Clinical use for finasteride?

Flutamide?

Answer 9

Finasteride (5a-reductase inhibitor) - DPH, male-patterned baldness
Flutamide (testosterone R inhibitor) - prostate CA

Question 10

What causes:
Female pseudohermaphrodite (XX + ambiguus genitalia)
Male pseudohermaphrodite (XY + ambiguus genitalia)

Answer 10

Female = congenital adrenal hyperplasia
Male = androgen insensitivity syndrome

Question 11

Normal female external genitalia + no internal genitalia + bilateral lumps in labia majora

Answer 11

Androgen insensitivity syndrome - labs will show increased LH and testosterone
External = no DHT, default female
Internal = Sertoli cells produce MIF to cause paramesonephros to regress, but testosterone cannot maintain mesonephros development
Testes in labia majora = SRY gene from Y chr comes before testosterona/DHT to induce testis formation

Question 12

Ambiguus genitalia until puberty

Answer 12

5a-reductase deficiency - labs will show normal testosterone and LH
No DHT = default female external genitalia
Testosterone increases enough during puberty to cause external genitalia to masculinize

Question 13

Primary amenorrhea + anosmia

Answer 13

Kallmann syndrome - impaired migration of cells that secrete GnRH and that form the olfactory bulb

Question 14

Fried egg cells

Answer 14

Testicular seminoma, oligodendrogliomas, and HPV koilocytes

Question 15

Scrotal pain that improves when lifted

Scrotal pain that does not improve when lifted

Answer 15

Epidydimitis

Testicular torsion

Question 16

Schiller-Ducal bodies + elevated AFP

Answer 16

Yolk sac tumor

Question 17

Painful testicular lump + elevated hCG

Answer 17

Embryonal tumor

Question 18

Multinucleate giant cells + elevated hCG

Answer 18

ChorioCA (syncitiotrophoblasts)

Question 19

Elevated hCG and AFP

Answer 19

Teratoma

Question 20

Eosinophilic rod-shaped inclusions (Reinke crystals) + gynecomastia

Answer 20

Leydig cell tumor - secretes testosterone (visualization in females) that is converted peripherally to estrogen

Question 21

Testicular lump + gynecomastia (without unique histology findings)

Answer 21

Stroll cell tumor - secretes estrogen

Question 22

3 indications for PDE5 inhibitors

Answer 22

Erectile dysfunction, raynaud syndrome, and primary pulmonary HTN

Question 23

3 side effects of PDE5 inhibitors

Why can they not be taken with nitrates?

Answer 23

Headache (vasodilation), dyspepsia, blue-green color vision loss (cross-over with retinal PDE, “Little blue pill”)
Life threatening HoTN

Question 24

What is Bowen’s disease, erythroplasia of Queyrat, and Bowenoid papulosis? Which can progress to SCC?

Answer 24

Bowen disease = leukoplakia on pencil shaft
Erythroplasia of Queyrat = erythroplakia on glans
Bowenoid papulosis = red papules on penis of younger men
Only Bowen and Queyrat progress to SCC

Question 25

Why is the mechanism for Tamsulosin unique?

Answer 25

Specific a-1A/D blocker (specific to the prostate) = BPH

Question 26

What stage of meiosis are eggs arrested in before ovulation?

Answer 26

Prophase 1 (condensed chr)

Question 27

What stage of meiosis are eggs arrested in after ovulation?

Answer 27

Metaphase 2 (chr aligned on metaphase plate)

Question 28

How many days after ovulation can fertilization occur? When does implantation occur?

Answer 28

Fertilization - within 1 day | Implantation - 6 days after ovulation

Question 29

How does suckling affect hormones of lactation?

Answer 29

Increases prolactin (milk production, suppress ovulation) and oxytocin (milk let down)

Question 30

What must be supplemented to infants that are exclusively breast fed?

Answer 30

Vitamin D

Question 31

What is the order of Tanner stage development for girls?

Answer 31

Breast bugs - pubic hair - menarche

Question 32

Which birth control method can decrease bone mineral density?

Answer 32

Depo-provera shots (progestin-only)

Question 33

Vulvar pruritis + smooth white plaques + thin epidermis

Answer 33

Lichen sclerosis - increases risk for SCC

Question 34

What is the main risk factor for vaginal adenoCA?

Answer 34

DES exposure in utero (retained columnar cells in vaginal mucosa) - also causes T-shaped uterus

Question 35

Grape-like clusters in the vagina of a young girl | What is the histological marker?

Answer 35

Sarcoma botryoides | Desmin + (rhabdomyosarcoma, has cross-striations)

Question 36

How do E6 and E7 protein expression in HPV cause cancer?

Answer 36

E6 degrades p53, E7 inactivates Rb

Question 37

What is the mechanism of Danazol?

Answer 37

Androgen R PA

Question 38

What are the 2 indications for Danazol?

Answer 38

Endometriosis (inhibits FSH/LH to suppress cycles) and hereditary angioedema (stimulates C1 esterase inhibitor synthesis)

Question 39

What are the 3 most common gynecological tumors?

Answer 39

Endometrial (best prognosis) > ovarial (worst prognosis) > cervical

Question 40

What is the mechanism of Leuprolide? | What is the mechanism of Clomiphene?

Answer 40

Leuprolide - GnRH analog (continuous antagonist, pulsitile agonist) Clomiphene - SERM estrogen antagonist in the hypothalamus (only works as an agonist) = both are used to stimulate ovulation, but Leuprolide can also be used to suppress cycles (leiomyomas, endometriosis)

Question 41

Enlarged tender uterus | Enlarged non-tender uterus

Answer 41

Tender - adenomyosis | Non-tender - leiomyoma

Question 42

What type of estrogen is increased in PCOS and why? What does this cause?

Answer 42

Estrone - elevated androstenedione is converted by peripheral aromitase into estrone Chronic estrone elevation suppresses follicular development

Question 43

What is the primary cause of PCOS?

Answer 43

Hypothalamic/pituitary dysfunction causing more LH to be secrete than FSH

Question 44

What is the 1 non-reproductive side effect of clomiphene?

Answer 44

Visual disturbances (retinal toxicity)

Question 45

Ovarian tumor is associated with simultaneous primary endometrial CA

Answer 45

Endometrioma (benign germinal epithelial tumor)

Question 46

Brennor tumor

Answer 46

Benign ovarian tumor of bladdar transitional epithelium

Question 47

Dermoid cyst

Answer 47

Benign teratoma

Question 48

Meigs Syndrome

Answer 48

Ovarian fibroma + ascites + hydrothorax

Question 49

Ovarian tumor with fallopean-like epithelium

Answer 49

Serious cystadenoma/cystadenoCA (benign germinal epithelial tumor)

Question 50

Ovarian tumor associated with psammoma bodies

Answer 50

Serous cystadenoCA

Question 51

Ovarian tumor that causes Pseudomyxoma peritonei (mucus ascites)

Answer 51

Mucinous cystadenoCA

Question 52

Primary tissue found in immature teratoma

Answer 52

Immature neuroectoderm

Question 53

Ovarian tumor with fried egg cells

Answer 53

Dysgerminoma

Question 54

Ovarian tumor markers hCG and LDH AFP hCG

Answer 54

Dysgerminoma Yolk-sac tumor ChorioCA

Question 55

Ovarian tumor with call-exner bodies (primordial follicles)

Answer 55

Granulosa cell tumor - normally outlines follicles, tumor produces so many cell they form follicles without the oocyte in the middle

Question 56

What 3 ovarian tumors are most commonly bilateral?

Answer 56

Serous cystademona, endometrioma, and teratomas

Question 57

Krukenburg tumor

Answer 57

GI tumor (typically gastric) that metastasizes to the ovaries - signet cell adenoCA (mucin-secreting)

Question 58

Mole without maternal DNA and higher risk for chorioCA

Answer 58

Complete mole

Question 59

Antihypertensives safe in pregnancy | "Hypertensive Mothers Love Nifedipine"

Answer 59

Hydralazine, a-methyldopa (a2 agonist), labetalol, and nifedipine

Question 60

What is given during pre-eclampsia to prevent seizures

Answer 60

Mg Sulfate

Question 61

HELLP syndrome (a type of pre-eclampsia)

Answer 61

Hemolysis + Elevated Liver enzymes + Low Platelets | Thrombosis in liver = platelet consumption, RBC shearing, and liver ischemia (elevated LFTs)

Question 62

What are 2 fetal malformations associated with pre gestational DM?

Answer 62

Transposition of the great vessels and caudal regression syndrome

Question 63

Bleeding in the 3rd trimester: Painful Nonpainful

Answer 63

Painful - placental abruption (retained blood irritates the uterus) Nonpainful - placenta previa (bleeding immediately out the cervix)

Question 64

What are 2 risk factors for ectopic pregnancy that are unrelated to fallopian tube scarring?

Answer 64

Smoking (decreases epithelial ciliary motility) and fertilization when IUD is placed

Question 65

What drugs cause gynecomastia? | "Some Drugs Cause Awesome Knockers"

Answer 65

Spironolactone, digoxin, cimetidine, alcohol (chronic), ketoconazole

Question 66

Breast stream hyperplasia + blue dome cysts + fluctuates with cycle

Answer 66

Fibrocystic change

Question 67

Breast increased number of glands + intraductal fibrosis + calcification

Answer 67

Sclerosing adenosis

Question 68

Breast scar with irregular edges, looks like fat necrosis

Answer 68

Radial scar (complex sclerosing)

Question 69

Mobile breast mass with sharp edges in a patient under 25, changes with hormones

Answer 69

Fibroadenoma - benign

Question 70

Straw colored/bloody nipple discharge

Answer 70

Intraductal papilloma - benign tumor within the ducts just beneath the areola

Question 71

Large breast mass with leaf-like projections on histology

Answer 71

Phyllodes tumor - benign

Question 72

Intraductal caseous necrosis with central calcification

Answer 72

DCIS - comedoCA

Question 73

Eczematous rash or ulceration of the nipple

Answer 73

Paget's disease of the breast (DCIS that migrates out the nipple)

Question 74

Signet ring cells that are ER/PR +

Answer 74

LCIS or invasive lobular CA

Question 75

What form of breast cancer arises from inactivation of E cadherin

Answer 75

Invasive lobular CA

Question 76

Pt diagnosed with molar pregnancy, what is most likely see in the ovary?

Answer 76

Theca-lutein cyst - stimulated by high hCG