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Flashcards in Repro Deck (39)
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1
Q

Complete mole

A

46 XX or 46 XY - 1 sperm divides and fertilizes empty egg

  • VERY high beta-hCG
  • increased uterine size
  • NO fetal parts

Risk: 2% choriocarcinoma, 15-20% malignant trophoblastic disease (invades through uterine wall)
- Monitor beta-hCG after evacuation

Tx: dilation currettage, methotrexate

2
Q

Partial mole

A

69 XXX, 69 XXY, 69 XYY

  • 2 sperm and 1 egg
  • slight increase in beta-hCG
  • Fetal parts

Risk: low risk of malignancy (<5%)

Tx: dilation currettage, methotrexate

3
Q

Preeclampsia

A

Preeclampsia= HTN, proteinuria, edema

  • Occurs in 7% women from 20 weeks gestation to 6 weeks postpartum
  • Before 20 weeks= molar pregnancy likely

Eclampsia= preeclampsia + seizures

Etiology:

  • Increased incidence in pre-existing HTN, diabetes, chronic renal disease, autoimmune disorders
  • Defect in uterine vasculature–> increased vascular tone

HELLP syndrome= Hemolysis, Elevated Liver enzymes, Low Platelets

Mortality: cerebral hemorrhage, adult respiratory distress syndrome

Treatment:
- IV magnesium sulfate: prevention and treatment for seizures

4
Q

Abruptio placentae

A

Premature detachment of placenta

  • Associated with DIC?
  • Increased risk with smoking, HTN, cocaine

Symptoms:
- Painful bleeding in 3rd trimester (Abrupt detachment)–> life threatening to fetus and mother

5
Q

Placenta accreta

A

Scar tissue in myometrium–> defects in decidual layer–> allows placenta to adhere to tissue
- increased bleeding risk after delivery

    • Retained placental tissue: increased risk of infection
  • Bacteroides= most commonly isolated (mixed flora infection)
6
Q

Placenta previa

A

Placenta attaches to lower uterine segment
- Increased risk with multiparity, C-section

Symptoms:
- PainLESS bleeding in any trimester

7
Q

Ectopic pregnancy

A

** Lower than expected beta-hCG

8
Q

Polyhydramnios

A

> 1.5-2 L amniotic fluid–>
Due to:
- esophageal/duodenal atresia: Can’t swallow amniotic fluid
- Anencephaly (can’t swallow w/o brain

9
Q

Cervical dysplasia/CIN

A

HPV 16–> E6–> inhibit p53
HPV 18–> E7–> inhibit Rb

  • Increased risk with multiple sexual partners (#1), smoking, early debut, HIV infection
10
Q

Gynecologic tumor epidemiology

A

Worldwide: Cervical cancer most common

Incidence (US):

  1. endometrial
  2. ovarian
  3. cervical

Highest mortality:

  1. ovarian
  2. Cervical
  3. Endometrial
11
Q

Clear cell adenocarcinoma of vagina

A

DES exposure in utero–> seen in adulthood

12
Q

Sarcoma botyoides

A

Rhabdomyosarcoma

  • girls < 4 years of age
  • Spindle-shaped tumor cells= desmin positive
13
Q

CA-125

A

Cancer antigen elevated in serous, endometrioid, clear cell carcinoma of ovary
- Used to monitor therapeutic response

14
Q

Malignant breast cancer

A

Common post-menopause
Usually arise from terminal duct lobular unit

Overexpression of:

  • Estrogen/progesterone receptors
  • c-erbB2 (HER-2= EGF receptor)
15
Q

Leuprolide

A

GnRH analog:

  • Agonist when used in pulsatile dosing (infertility drug)
  • Antagonist when used continuously (prostate cancer, uterine fibroids, precocious puberty treatment)

Tox:
- Antiandrogen, N/V

16
Q

Testosterone

A

MOA: Agonist at androgen receptors

Use: Treats hypogonadism

  • Promotes secondary sex characteristics
  • Anabolic steroid- burn or injury recovery

Tox:

  • Masculinization in famles
  • Inhibits LH release (negative feedback)–> gonadal atrophy
  • Premature epiphyseal plate closure
  • Increased LDL, decreased HDL
17
Q

Finasteride

A

MOA: 5-alpha-reductase inhibitor
- Decreases conversion of T–> DHT

Use:

  • BPH
  • Male-pattern baldness
18
Q

Flutamide

A

MOA: nonsteroidal inhibtor of androgens at testosterone receptor

Use: prostate cancer

19
Q

Ketoconazole

A

MOA: inhibits steroid synthesis (inhibits 17,20-desmolase)

Use:
- PCOS (prevent hisutism)

Tox: gynecomastia, amenorrhea

20
Q

Spironolactone

A

MOA: inhibits steroid binding

Use:
- PCOS (prevent hisutism)

Tox: gynecomastia, amenorrhea

21
Q

Ethinyl estradiol, DES, Mestranol

A

MOA: bind estrogen receptors

Use:

  • Hypogonadism, ovarian failure
  • Menstrual abnormalities
  • HRT in post-menopauseal women
  • Androgen-dependent prostate cancer

Tox:

  • Increased endometrial cancer risk
  • Bleeding in post-menopausal women
  • DES in utero exposure–> clear cell adenocarcinoma of vagina
  • Thrombosus
    • Avoid in ER-positive breast cancer, previous history of DVT
22
Q

Clomiphene

A

MOA: SERM

  • Partial agonist at estrogen receptors in hypothalamus (prevents normal feeback inhibition)
  • Increases LH, FSH release

Use: infertility, PCOS

Tox:

  • Hot flashes
  • Ovarian enlargement
  • Multiple simultaneous pregnancies
  • Visual disturbances (enlarged pituitary)
23
Q

Tamoxifen

A

MOA: SERM
- Antagonist on breast tissue, agonist of endometrium

Use: treat, prevent recurrence of ER-positive breast cancer

24
Q

Raloxifene

A

MOA: SERM
- Agonist on bone–> reduces resorption

Use: Osteoporosis

25
Q

Anastrozole, Exemestane

A

Aromatase inhibitors

Use: postmenopausal breast cancer (estrogen-sensitive cancer)

26
Q

Progestin

A

MOA: bind progesterone-R, reducing growth and decreasing vascularization of endometrium

Use:

  • oral contraceptives
  • Endometrial cancer
  • AbnL uterine bleeding
27
Q

Mifepristone (RU-486)

A

MOA: competitive inhibitor of progestins at progesterone-R

Use: terminate pregnancy (administered with misoprostol= PGE1)

Tox: Heavy bleeding, GI effects (N/V/A), abdominal pain

28
Q

Oral contraceptives (progestin + estrogen)

A

MOA: inhibit LH/FSH release–> prevent estrogen surge–> no LH surge–> no ovulation
- Progestins= thicken cervical mucus (barrier); inhibit endometrial proliferation (no implantation)

29
Q

Terbutaline

A

MOA: beta-2 agonist, relaxes uterus

Use: reduce premature contractions

30
Q

Tamulosin

A

MOA: alpha-1 antagonist, inhibits smooth m. contraction (selective for alpha 1A,D receptors in prostate vs alpha 1B in vasculature)

Use: BPH

31
Q

Sildenafil, Vardenafil

A

MOA: inhibit PDE-5–> increased cGMP–> smooth muscle relaxation in corpus cavernosum (increased blood flow–> erection)

Use: Treat ED

Tox: H/A, flusing, dyspepsia, impaired blue-green color vision
- Avoid in patients taking nitrates–> hypotension

32
Q

Danazol

A

MOA: synthetic androgen; partial agonist at androgen receptors

Use: endometriosis, hereditary angioedema

Tox:

  • Weight gain, edema
  • Acne, hirsutism, masculinization
  • Decreased HDL, hepatotoxic
33
Q

Sources of estrogen in female

A

Ovary (17-beta estradiol), placenta (estriol), adipose tissue (estrone via aromatization)

  • GnRH–> LH–> desmolase in Theca cell
  • -> Cholesterol converted to androstenedione
  • GnRH–> FSH–> aromatase in Granulosa cell
  • –> Androstenedione converted to astrogen

Estrogen–> increased transport proteins, SHBG; increased HDL, lowered LDL; causes LH surge–> ovulation

** Potency: estradiol > Estrone > estriol

34
Q

Oogenesis

A

Meiosis I= prophase I; primary oocyte (until ovulation)

Meiosis II= Metaphase II; secondary oocyte (until fertilization)

35
Q

Lactation

A

Progesterone decreases at birth–> lactation begins

  • Prolactin= binds JAK-STAT pathway–> induce and maintain lactation, prevent ovulation
  • Oxytocin= milk letdown
36
Q

hPL

A

Human placental lactogen

  • Secreted from syncytiotrophoblast
  • Similar to prolactin, GH
  • Increases maternal insulin resistance, decreases maternal glucose utilization, increases blood glucose
  • -> increased lipolysis, proteolysis (energy for mom as baby uses glucose)
    • Maternal insulin resistance d/t: hPL, GH, estrogens, progesterone, glucocorticoids
  • Gestational diabetes= unable to overcome insulin resistance
37
Q

Alpha-fetoprotein (AFP)

A

Synthesized in liver, GI tract, yolk sac

  • Serum AFP low in: Down’s syndrome, increased gestational age
  • Elevated AFP: dating error (most common cause), neural tube defects, gastro wall defects, multiple gestations
38
Q

Endometritis

A

Inflammation of endometrium d/t:

  • Retained products of conception following delivery
  • Miscarriage/abortion
  • Foreign body (IUD)

Bacteroides= common infection

Treatment:
- Gentamycin + Clindamycin
+/- Ampicillin

39
Q

Fibrocystic change in breast

A

Most common cause of breast lumps from 25- menopause

  • Premenstrual breast pain, bilateral, multiple lesions
  • Fluctate in size, mass
  • Does NOT indicate increased risk of carcinoma

Fibrosis= hyperplasia of stroma

Cystic= fluid-filled blue dome (ductal dilation)

Sclerosing adenosis= increased acini, intralobular fibrosis; associated with calcifications (confused with cancer)

Epithelial hyperplasia= increased epithelial cells in terminal duct lobule (increased risk of cancer if atypical cells)