Reproductive Flashcards
(221 cards)
1
Q
Boy is found to have rudimentary uterus and mass in inguinal canal on ultrasound. Biopsy of mass shows seminiferous tubules.
- Diagnosis?
- Pathophys?
A
- Persistent Mullerian Duct Syndrome
- Autosomal recessive congenital disorder causing Inadequate MIF from Sertoli cells that leads to lack of mullerian duct regression and a uterus develops. Testes did not descend.
Mullerian Duct -> fallopian, uterus, vagina
2
Q
Boy with delayed development, short stature, hypotonia (poor suckling), obesity, small hands and feet, and hypogonadism.
- Diagnosis?
- Pathophys?
A
- Prader willi
2. 15q12 deletion of paternal chromosomes (maternal imprint)
3
Q
Vessels in the suspensory ligament?
A
ovarian
4
Q
Vessels in the cardinal ligament?
A
uterine
5
Q
Pregnant patient 32 weeks presents with significant smoking history, sudden onset ab pain, dark red vaginal bleeding, fetal tachycardia, and tender uterus with contractions.
- Diagnosis?
- Pathophys?
A
- Abruptio Placentae
- premature separation of placenta from uterine wall during 3rd trimester that may result in fetal death and DIC
Risks: HTN, smoking, trauma, cocaine
6
Q
Patient lacks sense of smell, has been trying to get pregnant for 1 year unsuccessfully, history of multiple recent upper RTIs, and apex of heart felt in 5th right ICS.
- Diagnosis?
- Pathophys?
A
- Kartagner’s
- defect in dynein that affects heavy chains of cilia causing decreased fallopian tube function and ectopic pregnancy. In men, it causes azoospermia. Situs inversus is associated with it.
7
Q
Woman with hirsutism, weight gain, dark skin under axilla, irregular menstrual cycles, and infertility. Elevated LH.
- Diagnosis?
- Pathophys?
- Treatment?
A
- Polycystic Ovarian Syndrome (PCOS)
- insulin resistance leading to hyperinsulinemia alter feedback mechanism to increase LH:FSH causing unruptured follicles and anovulation
- Weight reduction and OCP to decrease estrogen. OCPs up regulate sex hormone binding globulin (SHBG) which reduces unbound testosterone.
Clomiphene for pregnancy
Flutamide for hirsutism
8
Q
Role of Dihydrotestosterone?
A
differentiation of penis, scrotum, prostate
Genital tubercle -> Glans Penis
Labioscrotal swelling -> scrotum
Urogenital sinus -> prostate
9
Q
Capitation insurance?
A
routine services for a fixed cost
10
Q
Man cannot conceive with low Androgen binding protein (ABP), low testosterone, and elevated FSH.
- Diagnosis?
- Pathophys?
A
- Sertoli cell defect
- ABP is synthesized by sertoli cells to maintain local testosterone for spermatogenesis. Lack of ABP causes pituitary to increase FSH to increase testosterone and ABP. Inhibit B from sertoli cells also have feedback inhibition on pituitary.
11
Q
Drug A exerts effect at lower dose but Drug B causes more decrease in pain response.
Potency vs Efficacy?
A
Drug A= potent
Drug B= efficacy
12
Q
Pregnant woman without history of HTN presents with HTN after week 25, proteinuria, blurry vision, and altered mental status.
- Diagnosis?
- Pathophys?
- Complications?
- Treatment?
A
- Preeclampsia
- abnormal placental spiral arteries cause endothelial dysfunction, vasoconstriction, and ischemia
- DIC confirmed by D-dimers
Acute fatty liver
ATN
HELLP (hemolysis, elevate liver enzymes, low platelets)
- Labetalol (Anti-HTN)
IV magnesium sulfate for seizures
-continually check deep tendon reflexes for magnesium toxicity, coma will follow.
Delivery after 37 weeks
13
Q
Routine 16th week checkup shows increased alpha fetoprotein.
- Diagnosis?
- Pathophys?
A
- Open Neural tube defect
- defective primary neurulation from folate deficiency, radiation, valproic acid, methotrexate, malnutrition, or genetics
14
Q
Beta-HCG?
A
- secreted from syncytiotrophoblasts after fertilization
- has identical alpha subunit to TSH, LH, and FSH
- pregnancy test marker
15
Q
What hormone allows doctor to tell an expecting mother the sex of the baby at 15 weeks?
A
Dihydrotestosterone
- produced from testosterone by 5a-reductase
- forms male external genitalia
16
Q
After AVM surgery on middle meningeal artery, patient cannot hear low pitched sounds.
Diagnosis?
A
Tensor tympani muscle supplied by Trigeminal Nerve V3 which exits foramen ovale and travels close to the artery
-Stapedius supplied facial nerve causes increased sensitivity to sounds
17
Q
Mother has a history of diabetes and small uterus. Infant presents with hypo plastic lungs, flat face, and clubbed feet.
- Diagnosis?
- Pathophys?
A
- Potter syndrome
2. pregestational diabetes and B/L renal agenesis cause oligohydramnios which lead to hypo plastic lungs.
18
Q
Patient with painful penile ulcer that bleeds and inguinal lymphadenopathy with purulent discharge.
- Diagnosis?
- Pathophys?
- Treatment?
A
- Chancroid
- Haemophilus ducreyi (gram- coccobacillus) is a STD that causes painful genital ulcers
- if painless: Treponema pallidum (syphilis), gram negative spirochete - Azithromycin
Ceftriaxone
Ciprofloxacin
19
Q
7 year old boy with body odor from axilla and genital pubic hair.
- Diagnosis?
- Pathophys?
A
- Precocious puberty
- appearance of secondary sex characteristics before age 9 due to increased sex hormones
- central: increased GnRH (idiopathic, CNS tumors)
- peripheral: increased hormone production or exogenous exposure
20
Q
Patient giving birth suffered perineal tear and later experienced fecal incontinence.
Diagnosis?
A
External anal sphincter tear
21
Q
Child born with cliteromegaly has been raised a girl. She is reaching puberty and is experiencing increased body mass, deep voice, growth of penis, and lack of menstruation. Normal levels of testosterone, estrogen, and LH. Genotyping shows XY.
- Diagnosis?
- Pathophys?
A
- 5a Reductase deficiency
- 5a Reductase converts testosterone to DHT which differentiates penis, scrotum, and prostate. Male internal genitalia but not external until puberty when testosterone increases.
22
Q
Girl found with bilateral undescended testes, and no uterus. Testosterone, estrogen, and LH are high.
- Diagnosis?
- Pathophys?
A
- Androgen sensitivity syndrome
- Androgen receptor defect results in normal appearing female that is XY. Testes develop due to SRY gene and produce testosterone that inhibits mullerian ducts and uterus formation. Male genitalia doesn’t form due to defect in receptor. Testes are removed to prevent malignancy.
23
Q
Pregnant woman presents with deeper voice. Infant born with ambiguous genitalia, increased testosterone and androstenedione.
- Diagnosis?
- Pathophys?
A
- Placental aromatase deficiency
2. aromatase synthesizes estrogens from androgens. Female infant becomes masculinized. Fetal androgens cross placenta.
24
Q
Girl that hasn’t experienced puberty has no smell and no secondary sex characteristics at age 16. Decreased GnRH, FSH, LH and testosterone.
- Diagnosis?
- Pathophys?
A
- Kallman Syndrome
- defective migration of GnRH and failure of olfactory bulbs.
Hypogonadotropic hypogonadism
25
Old woman with new onset postmenopausal bleeding and left adnexal mass with endometrial stripe. Biopsy shows granulosa cells with eosinophils.
1. Diagnosis?
2. Pathophys?
1. Granulosa cell tumor
2. endometrial hyperplasia from unopposed estrogen from ovarian tumor. Call exner bodies present. Risk of endometrial carcinoma.
26
Patient with testicular mass that does not transilluminate. AFP is high. Biopsy shows yellow demarcated mass with tissue that resembles primitive glomeruli with eosinophils.
1. Diagnosis?
2. Pathophys?
1. Yolk sac tumor (endodermal sinus)
| 2. malignant endodermal cells secrete AFP. Contain schiller duval bodies.
27
Giemsa stain of urethral discharge shows intractyoplasmic inclusions in person with multiple sex partners. Person has follicular conjunctivitis.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Chlamydiae trachomatis
2. EB are infectious and enter cell by endocytosis where they replicate by fission as reticulate body
3. Azithromycine or Doxycycline
- add Ceftriaxone if gonorrhea
28
Tanner stages?
1. no secondary characteristics
2. breast buds
3. coarse pubic hair
4. raised areola (mound on mound)
5. pubic hair to medial thigh
29
Patient with fever and tender right breast after 3 months of breastfeeding.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Mastitis by S. aureus
2. cracks in nipple during feeding increase risk of infection. Abscess can form.
3. Drain abscess and continue breastfeeding. Engorged breasts exacerbate symptoms. Also give antibiotics.
30
Risks for breast cancer?
- early menarche
- late menopause
- more exposure to estrogen
- family history (BRCA)
- advanced age at first birth
- african
- obesity
31
Woman with high A1c, high LH to FSH ratio of 3:1, hirsutism, and dark skin at folds. US shows many cysts.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. PCOS
2. high insulin leads to insulin resistance that increases GnRH pulse frequency leading to increased LH and androgens.
3. Weight loss
OCPs (prevent endo hyperplasia from estrogen)
Clomiphene (blocks GnRH)
Flutamide (blocks androgens)
32
Diagnostic criteria for PCOS?
1. Anovulation
2. High androgens
3. Ovarian cysts
33
Woman with vulvar pruritus, dysuria, and odorless thick white vaginal discharge after taking antibiotics for 10 days for pneumonia. Gram stain shows hyphae with spores.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Vaginal candida
2. common in diabetes or after antibiotics. Vaginal pH is in normal range.
3. Fluconazole
34
Woman with frothy green foul smelling discharge and strawberry cervix.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Trichomonas vaginitis
2. motile pear shaped trichomonads in pH > 4.5
3. Metronidazole
- treat their partner
35
Woman with thin white vaginal discharge with fishy odor.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. bacterial vaginosis
2. clue cells in pH > 4.5
3. Metronidazole or Clindamycin
36
Pregnant woman with large uterus, very high HCG, and US showing snowstorm but no fetal parts.
1. Diagnosis?
2. Pathophys?
1. Complete hydatidiform mole
- partial shows fetal parts
2. 46XX paternally derived. Enucleated ovum is fertilized by single sperm and duplicates with paternal DNA. Cystic swelling of chorionic villi and proliferation of trophoblastic tissue without fetal tissue.
Partial= 2 sperm + 1 egg (69XXX)
37
Woman 32 weeks with sudden vaginal bleeding, cramps without trauma. Low BP and fast HR. Dark red blood in vaginal vault and hypertonic uterus. Fetus in distress. History of smoking and cocaine.
1. Diagnosis?
2. Pathophys?
1. Abruptio placentae
2. separation of placenta from uterine wall. Risks are smoking, cocaine, trauma, HTN, preeclampsia. Complications of DIC from tissue factor entering maternal circulation, maternal shock, and fetal death.
38
High grade CIN?
II= 1/3
III= 2/3 of epithelium
39
Woman with painful, itchy, crusty rash on nipple with burning sensation. Biopsy shows large cells with clear cytoplasm surrounding hyper chromatic nucleus.
1. Diagnosis?
2. Pathophys?
1. Paget disease
| 2. extension of underlying ductal carcinoma up lactiferous ducts and into nipple skin
40
Young man with painless right testicular lump with enlarged para-aortic LN. Elevated placental ALP.
1. Diagnosis?
2. Pathophys?
1. Seminoma
| 2. most common tumor of testicle. Large cells with fried egg appearance. Late metastasis and excellent prognosis.
41
Young gay male returned from trip to Caribbean with painless shallow genital ulcers and large ulcerated LN in inguinal region.
1. Diagnosis?
2. Organism?
3. Treatment?
1. Lymphogranuloma venerum
2. Chlamydia trachomatis (L1-L3 serotypes)
3. Doxycycline
42
Male with painless single well circumscribed genital ulcer and spirochetes on microscopy.
1. Diagnosis?
2. Organism?
1. Syphilis
| 2. Treponema pallidum
43
Patient with multiple painful vesicular shallow genital lesions and cowry bodies on microscopy.
1. Diagnosis?
2. Organism?
1. Herpes
| 2. HSV 1 or 2
44
Newborn with cataracts, hepatosplenomegaly, and continuous murmur.
1. Diagnosis?
2. Pathophys?
1. Rubella
| 2. mother with rubella can cause cataracts, PDA, and sensorineural hearing loss.
45
Infections that can be passed from mother to fetus?
```
Toxoplasmosis
Rubella
CMV
Herpes
HIV
Syphilis
```
46
Test shows leak from Dorsal vein to Saphenous vein on penis. Diagnosis?
Erectile dysfunction
47
Pregnant woman 7 weeks presents with sharp pains in lower abdomen, vaginal spotting, and high HCG (2000). US shows empty uterus.
1. Diagnosis?
2. Pathophys?
1. Ectopic pregnancy
2. PID (salpingitis), endometriosis, prior tubal surgery and altered tubal mobility increases risk of ectopic where embryo implants somewhere other than endometrium
48
Woman with ovarian fibroma, ascites, and plural effusion.
1. Diagnosis?
2. Pathophys?
1. Meigs syndrome
| 2. bundle of spindle shaped fibromas cause pulling sensation in groin
49
Woman with ovarian mass, sweating, nervousness, and weight loss.
1. Diagnosis?
2. Pathophys?
1. Struma ovarii
| 2. mono dermal teratoma of mature thyroid tissue causing symptoms of hyperthyroidism
50
Female with short stature, webbed neck, and amenorrhea.
1. Diagnosis?
2. Complications?
1. Turner 45 XO
2. cystic hygroma
bicuspid aortic valve
horseshoe kidney
preductal coarctation
51
Female with ambiguous genitalia, hyponatremia, hyperkalemia, and hypotension.
1. Diagnosis?
2. Pathophys?
1. Congenital adrenal hyperplasia
2. 21b hydroxylase deficiency causing decrease in aldosterone and cortisol. Progesterone accumulates and is redirected to produce androgens by 17a hydroxylase.
52
Patient presents with progressive dementia, uncontrolled movements in face and extremities. Family history of this with early death.
1. Diagnosis?
2. Pathophys?
1. Huntingtons
2. autosomal dominant mutation of chromosome 4 leading to trinucleotide repeats (CAG) in N-terminal region of huntingtin protein
53
Neonate with NRDS. US shows transposition of great vessels.
1. Pathophys?
2. Treatment?
3. Contraindications?
1. Aorta arises from RV sending deoxygenated blood to body
2. Prostaglandin (Alprostadil) that maintains ductus arteriosus
3. Indomethacin (NSAID) closes PDA causing death
54
Umbilical vessels?
2 arteries from internal iliac artery carry deoxygenated blood to placenta. They become the medial umbilical ligaments.
1 vein supplies oxygenated blood from placenta to fetus. Becomes ligamentum teres.
55
Infant with difficulty suckling and vomits after feedings following difficult delivery.
1. Diagnosis?
2. Pathophys?
1. Condylar compression (OA)
| 2. Vagus and Hypoglossal N. compressed
56
Child with elfin like face, low IQ, hypercalcemia, and valve disease.
1. Diagnosis?
2. Pathophys?
3. Tests?
1. Williams syndrome
2. elastin gene microdeletion on chromosome 7. High calcium from increased sensitivity to Vit D
3. FISH (fluorescence hybridization)
57
Postpartum female with low back pain and AL1 tender point and L1 dysfunction.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Abdominal or Iliopsoas (point medial to ASIS)
2. relaxin prepares body for delivery causing post partum pelvic dysfunction and low back pain
3. Counterstrain
58
Infant is delivered. Placental delivery is delayed and patient bleeds when placenta is extracted manually. US shows villi attached to myometrium.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Placenta accreta
- increta: penetrates myometrium
- percreta: penetrates myo and serosa
2. defective decidua causes placenta attachment to myometrium associated with Ashermans
3. Hysterectomy
59
Why is a Rh- mother given Rho(D) immunoglobulin?
Prevent maternal antibody recognition of fetal RBC and development of anti-D IgG antibodies which could affect her next pregnancy.
Baby must've Rh+ from father.
60
Tall thin female with long limbs presents with tearing chest pain radiating to back and differing BP in both arms.
1. Diagnosis?
2. Pathophys?
1. Aortic dissection from marfans
| 2. autosomal dominant point mutations of FBN1 gene on chromosome 15 causing fibrillin defect of connective tissue
61
Female with painless vaginal bleeding, normal uterus size, fetal heart tones, slightly elevated hCG, and +p57 stain.
1. Diagnosis?
2. Pathophys?
1. Partial hydatidiform mole
| 2. 2 sperm + 1 egg (69 XXX or XXY or XYY)
62
Female with painless vaginal bleeding, enlarged uterus, no fetal heart tones, very elevated hCG, and -p57 stain.
1. Diagnosis?
2. Pathophys?
1. Complete hydatidiform mole
2. enucleated egg + 1 sperm (46 XX or XY) shows snowstorm on US from trophoblastic proliferation. Cystic swelling of villi without fetal tissue.
63
Teenage male with hypogonadism is tall, slim, low weight and growing breasts. Has developmental delay.
1. Diagnosis?
2. Pathophys?
1. Klinefelter (47 XXY)
2. inactivated X chromosome causes dysgenesis of seminiferous tubules leading to increased FSH. Abnormal leydig cells causes decreased testosterone, increased LH, and increased estrogen.
64
Patient with recurrent fungal oral thrush, viral, and bacterial infections. CXR shows no thymic shadow or germinal centers.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. SCID
2. defective IL-2R gamma chain or adenosine deaminase deficiency causes failure of stem cell differentiation of B and T cells with absence of these cells on periphery
3. BM transplant, no live vaccines, IVIG
65
55 year old woman with hot flashes and mood swings.
1. Diagnosis?
2. Hormone imbalance?
3. Treatment?
4. ADR?
5. Contraindications?
1. Menopause
2. high FSH, low estrogen
3. Estrogen replacement
4. Hypercoagulation
5. contraindicated if VTE or endometrial cancer risk
66
Aldosterone levels in pregnancy?
Increased due to activation of RAAS which increases sodium retention. BP is unchanged due to increased GFR to compensate.
67
Infant born with jaundice is given phototherapy and returns to normal.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Physiologic jaundice
2. immature glucoronyl transferase increases water insoluble unconjugated bilirubin that crosses BBB.
3. Phototherapy solubilizes Br
68
Infant with cyanosis at feedings, low O2 sat, and systolic crescendo decrescendo murmur on left upper sternal border.
1. Diagnosis?
2. Pathophys?
1. Tetralogy of fallot (right to left)
2. VSD, Pulmonary stenosis, RV hypertrophy, and overriding Aorta from underdeveloped RV infundibulum hinders flow to lungs which is most noticeable with exertion (boot shaped heart). Children will often squat to breathe better.
69
Teenager with pan systolic blowing murmur over left sternal border with normal O2 sat.
1. Diagnosis?
2. Pathophys?
1. VSD (left to right)
| 2. malformed inter ventricular septum causes flow from high pressure LV to low pressure RV
70
Infant gets tired quickly while nursing. Persistent machine like flow murmur is heard throughout systole and diastole.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. PDA
2. blood flows from aorta to pulmonary a. associated with rubella and prostaglandins
3. NSAIDS to close it
71
Woman with uterine bleeding during first 20 weeks gestation, no pain, and closed cervix.
1. Diagnosis?
2. Treatment?
1. Threatened abortion
- if painful and cervix open= inevitable abortion
2. Bed rest
72
Infant born at 32 weeks presents with RR of 84/min and O2 sat 89%.
1. Diagnosis?
2. Pathophys?
3. Treatment?
4. ADR?
1. NRDS
2. Dipalmitoylphosphatidylcholine is produced by Type II pneumocytes (cuboidal cells) for surfactant optimal at 38 weeks. Decreased surfactant causes increased surface tension and decreased compliance. Infant has sufficient surfactant to survive by 26-28 weeks.
3. supplemental O2
- or corticosteroid before delivery enhances maturation of lungs
4. Free radicals from O2
73
First phenotypic sign of puberty in females?
Thelarche
74
Pregnant woman in 3rd trimester presents with painless bleeding. History of prior C-section. Bright red blood noted at external cervical os. No fetal distress.
1. Diagnosis?
2. Pathophys?
1. Placenta previa
| 2. abnormal placenta implantation at internal os.
75
Pregnant woman with new onset HTN and proteinuria. Then develops seizures.
1. 1st diagnosis?
2. 2nd diagnosis?
1. Preeclampsia
| 2. Eclampsia
76
Child with sensorineural hearing loss, notched peg shaped teeth, anterior bowing of tibia, and keratitis of cornea.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Congenital syphilis
2. Treponema pallidum
3. Penicillin G
77
Shortest diameter that baby has to pass through upon delivery? How to measure it?
1. Obstetric conjugate
- distance from superior pubic symphysis to sacral promontory
2. subtract 1.5-2cm from diagonal conjugate
- inferior symphysis to promontory
78
Child with developmental delay, gargoyle face (bulging frontal bones), corneal clouding, and airway obstruction.
1. Diagnosis?
2. Pathophys?
1. Hurler's
2. autosomal recessive deficiency of alpha-L-iduronidase causes accumulation of heparan and dermatan sulfate in lysosomes
79
African american presents with elevated Br and LDH, tachypnea, and fatigue after taking Sulfa drug.
1. Diagnosis?
2. Pathophys?
1. G6PD deficiency
2. X linked recessive deficiency causes decreased NADPH needed to reduce Glutathione causing buildup of free radicals and hemolytic anemia. Heinz bodies are removed by splenic macrophages forming Bite cells. Oxidizing agents like sulfa drugs and fava beans cause stress.
80
Jewish boy presents with hearing and vision loss. Cherry red sport seen on macula. No hepatosplenomegaly.
1. Diagnosis?
2. Pathophys?
1. Tay sachs
2. Hexosaminidase A deficiency causes accumulation of GM2 ganglioside in lysosomes of CNS. Ends with paralysis and death.
- Neimann picks is the same but with hepatosplenomegaly.
81
Young male with inguinal hernia lateral to epigastric.
1. Diagnosis?
2. Pathophys?
1. Indirect hernia
| 2. Patent processus vaginalis
82
Patient with cardiac and parathyroid defects causing hypocalcemia, and thymic hypoplasia.
1. Diagnosis?
2. Pathophys?
1. Digeorge Syndrome
| 2. 22q11 micro deletion causes failure of 3rd and 4th pharnyngeal pouch
83
Woman with history of copper IUD presents with ab pain and vaginal bleeding. Urine hCG is high.
1. Diagnosis?
2. Pathophys?
1. Ruptured ectopic pregnancy
| 2. low risk of pregnancy with copper IUD but higher risk of ectopic if it happens
84
Child with intellectual disability, seizures, growth retardation, and musty body odor. Phenyl ketones found in urine.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. PKU
2. deficiency in Phe hydroxyls or BH4 causes increased phenylalanine and decreased Tyrosine.
3. Tyrosine (becomes essential) and BH4 supplement
Avoid aspartame
85
How to determine when ovulating?
Body temp
-progesterone from corpus luteum after ovulation raises body temp
86
What maintains corpus luteum during 1st trimester of pregnancy?
hCG from syncytiotrophoblasts of placenta
87
Baby struggles to be delivered after head is through canal presents with adducted and internally rotated arm.
1. Diagnosis?
2. Pathophys?
1. Erb Duchenne palsy
| 2. shoulder dystocia due to damage of C5-C6 causing weakness of deltoid, biceps, and infraspinatus.
88
Pregnant woman with gestational diabetes. What will be the problem with her newborn?
1. Hypoglycemia due to Hyperinsulin
| 2. large for gestational age due to insulin
89
Pregnant woman on anti-seizure medication gives birth to child with microcephaly, dysmorphic face, hypoplastic nails and distal phalanges, and cardiac defect.
1. Diagnosis?
2. Pathophys?
1. Fetal Hydantoin Syndrome
| 2. Phenytoin increases Na+ inactivation
90
Patient with schizophrenia is having delusions. Medication is causing galactorrhea.
1. Diagnosis?
2. Pathophys?
1. Fluphenazine or Haloperidol
| 2. blocks D2 receptors causing decreased dopamine and increased prolactin.
91
When during pregnancy is the fetus most susceptible to teratogens?
weeks 3-8
-rapid cell division and differentiation of organs
92
Child with limited social interactions and repetitive restrictive behaviors.
1. Diagnosis?
2. Pathophys?
1. Autism
| 2. most likely caused by Fragile X which causes trinucleotide repeats in FMR1 gene
93
Infant born with neural tube defect. Diagnosis?
Folate deficiency weeks 3-8
94
Infant with underdeveloped mid facial region (thin lip, small palpebral fissures), microcephaly, and delayed CNS development.
Diagnosis?
Fetal alcohol syndrome
95
Infant with history of delayed separation of umbilical cord presents with increased neutrophils and recurrent infections that lack pus.
1. Diagnosis?
2. Pathophys?
1. LAD deficiency (auto recessive)
| 2. leukocytes cannot adhere to vessel wall and extravasate due to integrin deficiency
96
Neonate with pneumonia and meningitis?
Strep agalactiae
97
Infant with failure to thrive, jaundice, and cataracts after drinking breast milk.
1. Diagnosis?
2. Pathophys?
1. Galactosemia
2. absent galactose 1 phospate uridyltransferase causes accumulation of galactitol in lens of eye and liver. Predisposes to E. coli.
98
Patient with SLE and aortic stenosis gets pregnant and is at high risk for VTE.
1. Medication for abortion?
2. MoA?
1. Mifepristone
2. progesterone antagonist that causes detachment of pregnancy, opens cervix, and increases sensitivity to prostaglandin which causes contractions and expulsion of tissue.
99
Progesterone effect on cervical mucous?
Thickens to prevent entry of sperm
100
Drug to prevent maternal transmission of HIV?
1. NRTI (Zidovudine or Lamivudine)
| 2. competitively inhibits reverse transcriptase
101
Patient with thrombocytopenia, eczema, and recurrent infections.
1. Diagnosis?
2. Pathophys?
1. Wiskott aldrich
| 2. x linked recessive decreases in T and B cells causing decreases in IgM
102
Neonate with polyhydramnios and elevated AFP?
Anencephaly
-neural tube defect where cranial portion of neural tube fails to close during weeks 3-4
103
MoA of combined OCPs?
continual elevation of Estrogen and Progestins prevent LH surge by negative feedback
104
Child with inappropriate laughter, seizures, ataxia, and intellectual disability.
1. Diagnosis?
2. Pathophys?
1. Angelman
| 2. paternal imprint UBE3A on chromosome 15 (maternal deletion)
105
Patient with major depressive disorder.
1. Treatment?
2. MoA?
3. ADR?
1. SSRI (1st line)
2. block reuptake of serotonin which increases its effects
3. Weight gain, loss of libido, insomnia
106
African american with painful crises of joint pain, acute chest pain with pulmonary infiltrate, and splenomegaly after upper RTI.
1. Diagnosis?
2. Pathophys?
1. Sickle cell
2. autosomal recessive mutation in hemoglobin on chromosome 11p15. beta chain glutamic acid replaced by valine. Distorts RBC shape. Heterozygotes are resistant against malaria.
107
Pregnant patient 20 weeks presents with vaginal bleeding that is bright red and placenta encroaching over internal cervical os. Fetal heartbeat not in distress.
1. Diagnosis?
2. Risk factors?
1. Placenta previa
2. Prior C section
Number of pregnancies
Twin gestation
Curettage history
108
51 year old woman with postmenopausal bleeding, thickened endometrial stripe on ultrasound, and firm yellow ovarian mass.
1. Diagnosis?
2. Pathophys?
1. Granulosa cell tumor
2. tumor produces excess estrogen causing endometrial hyperplasia. Yellow indicates lipid.
Call exner bodies (coffee bean) in rosette pattern
109
Female with fever, yellow green vaginal discharge, and cervical motion tenderness. Gram stain shows gram negative diplococci.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. PID from Neisseria gonorrhoeae
2. type IV pili attach to host cells (primary virulence factor), antigenically variable pili
3. Ceftriaxone and Azithromycin
110
Young woman with dyspareunia, pelvic pain, and mobile lump in posterior vulva near orifice on one side.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Bartholin cyst
2. duct is blocked and fluid accumulates which may lead to abscess. Associated with Neisseria.
3. Drain and Abx
111
Patient has cyclic menstruation associated breast pain and has multiple bilateral small mobile lumps.
1. Diagnosis?
2. Pathophys?
1. Fibrocystic changes
| 2. proliferation of acini and interlobular fibrosis with low carcinoma risk
112
Female with unilateral eczematous nipple.
1. Diagnosis?
2. Pathophys?
1. Paget disease
| 2. underlying ductal carcinoma (large cells with halo) disrupt tight junctions of nipple
113
Male with absence of erections during REM, morning tumescence, and trouble getting erections.
1. Treatment?
2. MoA?
1. Sildenafil
| 2. inhibits cGMP phosphodiesterase which increases cGMP by NO leading to SM relaxation in corpus cavernous
114
What type of twins are at highest risk of complications?
Monochorionic Monoamniotic
- share chorion, amnion, and placenta
- split late (8-12 days after fertilization)
115
Oxytocin?
- contraction of uterus during labor
- milk ejection
- produced in paraventricular nucleus of hypothalamus
- stored in Herring bodies of posterior pituitary
116
Patient from East Africa presents with painful erythematous papule that progressed to an ulcer that is pus filled. No urethral discharge. Tender B/L inguinal LN.
1. Diagnosis?
2. Organism?
1. Chancroid
| 2. Haemophilus ducreyi
117
4 week old pregnant woman wants treatment for acne.
1. Treatment?
1. Nothing
Exposure to isotretinoin during weeks 3-8 is most damaging b/c of organogenesis
118
Female with pelvic pain, odorless discharge, dyspareunia, and cervical motion tenderness.
Diagnosis?
Neisseria gon (PID)
119
Pregnant patient with very high hCG, snowstorm on ultrasound, and no fetal heartbeat.
1. Diagnosis?
2. Symptom triad?
1. Complete Mole
2. Hyperemesis
Vaginal bleeding
Hyperthyroidism
120
Patient presents with multiple genital warts in perianal region.
Diagnosis?
HPV 6 and 11 (low risk)
121
Infant of 13 days presents with conjunctivitis, swollen lids, and purulent ocular discharge.
1. Diagnosis?
2. Pathophys?
1. Chlamydia trachomatis (D-K): 5-14 days after birth
- Neisseria: 2-5 days
2. neonates are exposed to it upon vaginal delivery and may cause pneumonia
122
Middle aged man with increased urinary frequency, incomplete bladder voiding, enlarged prostate, and mildly elevated PSA.
1. Diagnosis?
2. Treatment?
3. MoA?
1. BPH
2. Alpha 1 antagonist (Tamsulosin)
3. SM relaxers that act on bladder neck
123
Pregnant patient has single painless papule with firm base on vulva. Culture shows spirochete. Positive FTA-Abs test.
1. Diagnosis?
2. Organism?
3. Treatment?
4. MoA?
1. Primary syphilis
2. Treponema pallidum that can be passed to child
3. Benzylpenicillin G
4. binds bacterial transpeptidase and prevents crosslink of peptidoglycan
124
Patient presents with weight loss, heart palpitations, sweating, pulling sensation in groin, low TSH, high Thryoxine, and pelvic mass.
1. Diagnosis?
2. Pathophys?
1. Struma Ovarii
| 2. thyroid hormone secreting ovarian teratoma causes hyperthyroidism
125
Newborn with poor feeding, lethargy, elevated leucine and isoleucine, and maple odor to urine.
1. Diagnosis?
2. Pathophys?
1. Maple syrup urine disease (MSUD)
| 2. ketoacid DH complex deficiency blocks degradation of BCAA
126
Woman with severe ab cramps, menorrhagia, lower back pain with menstrual cycle, and has not responded to OCPs.
1. Diagnosis?
2. Pathophys?
3. Treatment?
4. MoA?
5. ADR?
1. Endometriosis
2. Retrograde menstruation, lymph drainage, metaplasia
3. GnRH agonists (Leuprolide, Goserelin)
4. continuous GnRH removes pulsatile stimulation of LH/FSH which decreases estrogen and inhibits endometrial growth
5. Osteoporosis and pseudomenopause
127
Patient presents with swollen tender left testicle, infertility, and no transillumination.
1. Diagnosis?
2. Pathophys?
1. Varicocele
2. dilated veins in pampiniform plexus increases venous pressure. Left more common b/c left gonadal drains into Left Renal vein
128
Patient with history of C sections, curettage, presents with excessive postpartum bleeding after delivery where placenta was delivered in pieces.
1. Diagnosis?
2. Pathophys?
1. Placenta accreta
| 2. placenta attaches to myometrium without penetrating it due to defective uterine decidual layer
129
Man involved in MVA presents with high riding boggy prostate, bloody urethral meatus, and pelvic fracture. Nurse failed to place Foley catheter.
Diagnosis?
1. Posterior Membranous urethral injury
130
Young female with abdominal pain during menstrual cycles. No hCG. Ibuprofen provides partial relief.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Primary Dysmenorrhea
2. Prostaglandin levels increase which constrict blood vessels and contract uterus causing ischemic pain
3. NSAIDS to block prostaglandins
131
50 year old female with hot flashes.
Hormone levels?
High FSH and LH with low estrogen due to menopause
-symptoms from estrogen
132
Women with cervical motion tenderness and purulent vaginal discharge and fever.
1. Diagnosis?
2. Treatment?
1. PID from Neisseria or Chlamydia
| 2. Ceftriaxone, Doxycycline, Metronidazole
133
Skateboarder comes in with straddle injury. Diagnosis?
Bulbar urethra injury
134
Patient presents with burning sensation with urination and positive leukocyte esterase and nitrite tests.
1. Diagnosis?
2. Treatment?
3. MoA?
4. ADR?
1. UTI from E. coli
2. Ciprofloxacin
3. Floroquinolone that inhibits DNA Gyrase counteracting DNA supercoiling (bactericidal)
4. Diarrhea, rash, headache, dizziness, tendon rupture, myalgia
135
6 month old with seizures, tachycardia, tachypnea, severe fasting hypoglycemia, and hepatomegaly. High lactic acid and TG.
1. Diagnosis?
2. Pathophys?
1. Von Gierke
| 2. G6Pase deficiency leads to decreased glycogenolysis and GNG and increased TG and lactic acid
136
Infant with painless scrotal mass that transilluminates.
1. Diagnosis?
2. Pathophys?
1. Hydrocele
| 2. serous fluid collects between tuna vaginalis
137
During inguinal surgery, nerve on top of spermatic cord is cut.
1. Nerve?
2. Symptoms?
1. Ilioinguinal N.
| 2. loss of sensation or numbest of scrotum and medial thigh
138
Pregnant woman is taking Valproic acid for seizures.
1. What is the risk for her child?
2. MoA?
1. Neural tube defect
- spina bifida
- meningocele
- myelomeningocele
2. Valproic acid causes Folate deficiency
139
Man with infertility has high FSH and LH, low testosterone. He has feminine body shape and long extremities.
1. Diagnosis?
2. Test to confirm?
1. Klinefelter
| 2. Karyotyping
140
Infant born with microcephaly, hearing loss, hepatosplenomegaly, and petechial rash. Head CT shows periventricular calcifications. Mom had sore throat, fever, and fatigue early in pregnancy.
1. Diagnosis?
2. Transmission?
1. Congenital CMV
| 2. transmitted transplacental
141
Woman with small firm contender mobile mass on lower inner quadrant of right breast. No skin or nipple changes. No LN.
1. Diagnosis?
2. Pathophys?
1. Fibroadenomas
2. most common benign breast tumor. Fibrotic interlobular stroma seen around normal duct and glands. Can calcify and cause hormonal changes.
142
Boy with urethral opening on dorsal aspect of penis.
1. Diagnosis?
2. Pathophys?
1. Simple Epispadias
| 2. abnormal development of genital tubercle which develops into glans penis or clitoris
143
Boy with urethral opening on ventral aspect of penis.
1. Diagnosis?
2. Pathophys?
1. Hypospadias
| 2. failure or urethral folds to fuse
144
Boy with hepatosplenomegaly, neurodegeneration, and cherry rad macula.
1. Diagnosis?
2. Pathophys?
1. Niemann Pick
2. absence of Sphingomyelinase which converts sphingomyelin into ceramide. Accumulation of sphingomyelin in macrophages causing foamy appearance.
145
Prenatal maternal serum shows low AFP, low unconjugated estriol, low hCG, and normal inhibin A.
1. Diagnosis?
2. Pathophys?
3. Infant features?
1. Trisomy 18 (Edwards)
2. nondisjunction of chromosome 18 in meiosis I results in three sets of chromosome in one cell
3. prominent occiput
rocker bottom feet
clenched fists
micrognathia
heart defects
146
Patient with red nonpruritic macule on palms and soles and condyloma lata.
Diagnosis?
Secondary syphilis
147
Woman presents with red ring lesions on body after using yoga mats at local gym.
1. Diagnosis?
2. Treatment?
3. MoA?
4. ADR?
1. Tinea corporis (ringworm)
2. Ketoconazole
3. blocks fungal membrane steroids, Desmolase and 17a hydroxylase.
4. Dark skin (desmolase)
Antiandrogenic: libido (hydroxylase)
148
Woman undergoing chemotherapy presents with vaginal inflammation and thick white discharge. Gram stain shows yeast with pseudohyphae.
1. Diagnosis?
2. Pathophys?
3. Complications?
1. Candida albicans
2. patient is immunocompromised
3. Esophagitis if CD4 <100
149
Woman with multiple miscarriages. She had partial failure of fusion of paramesonephric ducts.
Diagnosis?
Bicornuate Uterus
Didelphys= complete failure
150
2 month old boy with 2 small bilateral masses in inguinal canal. No textiles in scrotal sac.
1. Diagnosis?
2. Risks?
1. Cryptorchidism
| 2. undescended testicles are to warm and infertile. Increased risk of testicular germ cell tumors.
151
Woman with burning urination and foul smelling green frothy discharge. Increased vaginal pH.
1. Diagnosis?
2. Organism?
3. Treatment?
1. Trichomonas vaginalis
2. flagellated trophozoites
3. Metronidazole to patient and partner
152
Patient with septated ovarian mass, elevated hCG. Biopsy shows uniform fried egg cells in stroma with lymphocytes.
1. Diagnosis?
2. Metastasis?
1. Dysgerminoma
| 2. Para-aortic LN
153
Neonate with multiple recurrent bacterial and viral infections with absent thymic shadow.
1. Diagnosis?
2. Pathophys?
1. SCID
| 2. IL-2R gamma chain mutation (X linked:males) or adenosine deaminase deficiency (autu recessive)
154
In what instances is parental consent not required for minor?
1. sexual activity treatment
2. substance abuse
3. trauma
4. mental health
155
Woman with fishy vaginal odor and homogenous gray white discharge.
1. Diagnosis?
2. Organism?
3. Treatment?
4. MoA?
1. Bacterial vaginosis
2. Gardnerella vaginalis is a gram variable pleomorphic rod. Clue cells are vaginal epithelial cells covered with bacteria
3. Metronidazole
4. induces formation of free radicals that damages microbe DNA
156
Drugs given for abortion?
1. Mifepristone
- progesterone antagonist that disrupts maintenance of pregnancy
2. Misoprostol
- prostaglandin E agonist that stimulates uterine contractions to expel embryo
157
50 year old woman with red scaly patch on right nipple with discharge, palpable axillary LN, and firm mass in right breast.
1. Diagnosis?
2. Pathophys?
1. Paget
| 2. ipsilateral underlying ductal carcinoma and epithelium with large cells with prominent nucleoli with clear halo
158
Patient with history of multiple vaginal deliveries and stroke presents with urinary urgency, history of dribbling, and low post residual volume.
1. Diagnosis?
2. Pathophys?
1. Detrusor muscle overactivity
| 2. nerve damage to descending spinal inhibitory paths
159
Man with dysuria and watery urethral discharge. Giemsa shows dark brown inclusion bodies and few neutrophils.
1. Diagnosis?
2. Treatment?
3. MoA?
1. Chlamydia trachomatis
2. Azithromycin (macrolide) or Doxycycline (tetracycline)
3. Az: inhibits 50s ribosome to inhibit protein synthesis
Doxy: inhibits 30s ribosome
160
Unvaccinated child with fever and swelling of neck and testicles.
1. Diagnosis?
2. Organism?
3. Treatment?
1. Mumps
2. enveloped -ssRNA helical paramyxovirus
3. Ibuprofen and Acetaminophen and fluids for supportive care
161
Patient with weight loss, B/L ovarian mass, and stomach wall thickening. Biopsy shows mucin secreting cells. Left supraclavicular LN enlarged.
1. Diagnosis?
2. Pathophys?
1. Krukenberg tumor
2. gastric adenoca metastasis from stomach to ovaries
Signet ring cells
Virchow node
162
Oocyte arrested in what phase:
1. Before ovulation?
2. Before fertilization?
1. Prophase 1
2 Metaphase II
163
Man has difficulty starting and maintaining a urine stream, feeling like bladder is never emptied, urinary urgency, and dysuria.
1. Diagnosis?
2. Treatment?
3. MoA?
1. BPH
2. Finasteride
3. inhibits 5a Reductase which inhibits conversion of testosterone to DHT
- DHT stimulates growth of prostate
164
What is cut in a vasectomy?
Ductus (Vas) Deferens
165
Male with painless ulcerative lesion on penis.
What are the stages of this disease?
1. Primary syphilis (0-3 weeks)
- painless chancre on penis
2. Secondary (4-10 weeks)
- rash, condyloma lata, LN, hair loss, muscle aches, fever, sore throat
3. Tertiary
- subcutaneous granulomas (gum)
- dementia
- tabes dorsalis
- personality changes
166
Postmenopausal obese woman with heavy bleeding. Biopsy of endometrium shows proliferation with glandular invasion of myometrium.
1. Diagnosis?
2. Pathophys?
1. Endometrial carcinoma
| 2. obesity and late menopause increased exposure to estrogen
167
2 month old infant has fusion of fingers and toes (syndactyly).
Defect?
HOX gene defect
| -determines limb buds
168
Risk factors for cervical carcinoma?
1. early sex
2. multiple partners
3. smoking
4. low SES
169
Child with delayed development and growth, fair skin, eczema, and musty body odor.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. PKU
2. autosomal recessive deficiency in Phe hydroxylase or BH4 cofactor leads to accumulation of Phe. Tyrosine decreases which leads to a decrease in Dopamine.
3. Tyrosine and BH4 supplement
No Phe in diet (aspartame)
170
Pregnant woman with headache, blurry vision, HTN, and proteinuria. Medication is given in toxic dose.
1. Diagnosis?
2. Medication?
3. ADR?
1. Preeclampsia
2. Magnesium sulfate
3. Hyporeflexia (loss of deep tendon reflexes)
CNS depression
Respiratory depression
Coma
Cardiac arrest
171
Patient has respiratory infections and pancreatic failure.
1. Diagnosis?
2. Pathophys?
3. Diagnostic test?
1. Cystic fibrosis
2. CFTR gene mutation blocks ducts
3. PCR and sequencing
172
Infant with underdeveloped nails, cleft lip, and abnormal face. Mother was taking medication during pregnancy.
1. Diagnosis?
2. Cause?
1. Fetal Hydantoin syndrome
| 2. mother took Phenytoin during pregnancy for epilepsy
173
Woman with dyschezia, cyclic pelvic pain, dyspareunia, and dysmenorrhea.
1. Diagnosis?
2. Pathophys?
1. Endometriosis
| 2. endometrial tissue in rectouterine pouch causing dyschezia
174
15 year old boy with painless testicular mass that is highly sensitive to radiotherapy.
1. Diagnosis?
2. Pathophys?
1. Seminoma
| 2. large cells in lobules with watery cytoplasm and lymphocytes (fried egg)
175
Patient with indwelling foley catheter, lower ab pain, pyuria, +leukocyte esterase, fever, altered mental status. Nitrite negative. Culture+ on bile esculin agar.
Diagnosis?
1. Enterococcus UTI
| - gram negative convert nitrate to nitrite
176
Woman at midpoint of menstrual cycle present with unilateral ab pain, no signs of infection, and no pregnancy.
Mittelschmertz
177
Woman with HER2 breast cancer.
1. Treatment?
2. MoA?
1. Trastuzumab
| 2. monoclonal Ab against epidermal GF receptor 2 (HER2) kills breast cancer cells over expressing HER2
178
Erectile dysfunction from nerve damage. What nerves?
Parasympathetic S2-S4
-Sympathetic for ejaculation
179
Twinning stages?
0-4 days: dichorion diamnion
4-8 days: monochorion diamnion
8-12 days: monochorion monoamnion
13+ days: conjoined
180
Woman with suprapubic abdominal pressure, dysuria, polyuria, and history of three vaginal births. Progresses with fever and flank pain.
1. Diagnosis?
2. Pathophys?
1. Uterine prolapse with pyelonephritis
2. stretching of ligaments with vaginal birth causes prolapse which can compress ureters causing buildup of urine and hydronephrosis. Bacteria (E. coli) can proliferate
181
Male with breast cancer. Diagnosis?
Klinefelter XXY
182
Woman with abnormal uterine bleeding, abdominal pain, bloating, and mass on deep palpation. US shows benign mass.
1. Diagnosis?
2. Treatment?
3. MoA?
1. Leiomyoma
2. Leuprolide (GnRH agonist)
3. constant stimulation of GnRH receptors of pituitary gland which leads to desensitization and down regulation of receptors. This decreases hormones and tumor size.
183
Pathophys of ovarian torsion?
ovary rotates around infundibulopelvic ligament (suspensory) and ovarian ligament disrupting blood flow to ovary
184
36 year old woman with hot flashes, low estrogen and high FSH, and amenorrhea.
Diagnosis?
POI (anovulatory cycles)
185
Patient with history of RA has gastric ulcers from NSAIDs. She is prescribed a medication. She has headaches and abdominal pain. Patient may be pregnant and presents with vaginal bleeding. She also takes Phenytoin for seizures.
1. Diagnosis?
2. MoA?
3. Other drugs?
4. Treatment?
1. Misoprostol
2. Prostaglandin E1 analog that increases gastric mucous to treat ulcers, also induces uterine contractions and is used as abortifacent.
3. PPI and Cimetidine inhibits cyt P450, reducing breakdown of Phenytoin which leads to birth defects
4. Give H2 antagonist besides Cimetidine
186
Clomiphene
1. MoA?
2. Uses?
1. SERM that reduces estrogen feedback inhibition on hypothalamus which increases GnRH, FSH, LH which increases testosterone
2. Female infertility due to anovlation in PCOS
Male infertility to increase testosterone
187
Patient has extensive cancer and refuses treatment. what do you do?
respect their wishes and be available if they change their mind.
188
50 year old woman with hot flashes. What are her hormone levels?
Low estrogen
High FSH, LH, and GnRH
189
Infant with upslanting palpebral fissures, epicanthal folds, and depressed nasal bridge.
1. Diagnosis?
2. Pathophys?
3. Heart defect?
1. Down Syndrome
2. nondisjunction in meiosis 1, chromosomes do not separate in anaphase causing 3 chromosomes on one side
3. ASD
190
15 year old girl with breasts but no menstrual cycles. Short vagina with blind pouch.
1. Diagnosis?
2. Pathophys?
1. Mullerian agenesis (MRKH)
| 2. spontaneous degeneration of paramesonephric duct causing agenesis of upper vagina
191
Infant with urethral opening on ventral shaft on penis.
1. Diagnosis?
2. Pathophys?
1. Hypospadias
| 2. improper fusion of urogenital folds
192
Patient with dysmenorrhea and menorrhagia. Diffusely enlarged soft uterus.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Adenomyosis
2. extension of endometrial tissue into myometrium
3. hysterectomy or GnRH agonists
193
Dysplasia found at transformation zone. Diagnosis?
Cervical cancer (HPV 16 and 18)
194
Pregnant patient returns from camping trip with bullseye rash, fever, and muscle aches.
1. Diagnosis?
2. Treatment?
3. MoA?
4. ADR for infant?
5. Alternate treatment?
1. Borrelia burgdorgeri (lyme disease)
2. Doxycycline
3. prevents aminoacyl tRNA from binding to A site which blocks elongation of protein synthesis
4. enamel hypoplasia leading to discolored teeth in infant
5. Amoxicillin or Cefuroxime
195
Complication of hysterectomy?
surgeon must cut cardinal ligament (uterine arteries) which connects cervix to pelvic wall. Ureter is at risk which pass under these arteries
196
50 year old man with low back pain, increased PSA, PAP, and ALP.
1. Diagnosis?
2. Diagnostics?
1. Prostatic adenocarcinoma
| 2. rectal exam to feel posterior lobe of prostate
197
Woman recently returned from honeymoon presents with suprapubic pain, dysuria, hematuria, and fever.
1. Diagnosis?
2. Pathophys?
3. treatment?
1. Cystitis from UTI
2. E. coli fimbriae attach to epithelial cells of urinary tract
3. Amoxicillin
198
Patient with painful exudative genital ulcerative lesions, fever, and swollen inguinal LN.
1. Diagnosis?
2. Treatment?
1. Chancroid (Haemophilus ducreyi)
| 2. Ceftriaxone
199
Young man with frequent urination, low back pain, fever after being sexually active with multiple partners. Rectal exam shows warm and enlarged prostate.
1. Diagnosis?
2. Pathophys?
1. Acute prostatitis
2. chlamydia or neisseria in younger men.
E.coli or pseudomonas in older men.
200
Infant with microcephaly, wide spaced eyes, epicanthal folds and high pitched crying. Harsh sounding holosystolic murmur at left sternal border.
1. Diagnosis?
2. Pathophys?
1. Cri du chat with VSD
| 2. deletion of short arm chromosome 5
201
What is affected in ovarian torsion?
ovarian artery branching off aorta
202
Patient with abdominal distention, suprapubic tenderness, and menorrhagia. Ultrasound shows ovaries with blood filled cysts.
Endometriosis with chocolate cysts
203
African american woman with heavy menstrual bleeding and asymmetrically enlarged uterus. Biopsy shows cigar shaped nuclei with eosinophilic cytoplasm.
1. Diagnosis?
2. Pathophys?
1. Fibroids
| 2. increase with estrogen in pregnancy and decrease with menopause
204
Best prognostic predictor for breast cancer?
spread to axillary LN
205
Young man sexually active with multiple partners presents with vesicles on penis, headache, and fever.
1. Diagnosis?
2. Pathophys?
1. HSV2 (dsDNA enveloped linear virus) latent in sacral ganglia
2. viral meningitis from genital herpes
206
Blotting procedures?
Southern: DNA
Northern: RNA
Western: protein
SW: DNA binding protein
207
Infant with bifid scrotum.
Diagnosis?
Malunion of labioscrotal swelling during development
208
Young woman with genital warts after multiple sex partners. Biopsy shows koilocytes.
Diagnosis?
HPV 6 and 11 (dsDNA noneveloped circular virus)
209
Effects of hormone replacement therapy?
Decreased osteoporosis
increases risk of stoke or MI
increased breast cancer
210
Woman had clinical infection and was given broad spectrum abx. Presents with vaginal pruritus, white thick discharge, and pH of 4.2.
1. Diagnosis?
2. Pathophys?
1. Candida albicans (budding yeast with pseudohypahe)
| 2. abx eliminated lactobacilli (Gram+ facultative anaerobe) causing increased pH
211
Vaginal pH 4.0 and teaspoon of thick white discharge.
Normal
- not enough discharge
- pH= 4-4.5
212
Woman with suprapubic tenderness and heavy menses after having IUD placed 3 years ago.
1. Diagnosis?
2. Pathophys?
1. Endometritis
2. foreign objects promote infection by ureaplasma, gardnerella, GBS, and clamydia
Chronic: plasma cells
213
Postmenopausal woman with history of ER+ breast cancer presents with painless vaginal bleeding.
1. Diagnosis?
2. Pathophys?
1. Tamoxifen ADR
2. blocks ER at breast but is agonist of ER in endometrium increasing risk of endometrial cancer
Raloxifene: ER block at breast and endometrium
214
Most specific test to diagnose syphilis?
fluorescent treponema antibody absorption test
215
Neonate with hepatosplenomegaly, ascites, edema, and purport. Placenta is pale, thick, and enlarged. Mother's 2nd child.
1. Diagnosis?
2. Pathophys?
3. Treatment?
1. Hydrops fetalis (hemolytic disease)
2. mother is Rh- and is sensitized to Rh+ baby. mother IgG cross placenta and attack fetal RBC. poor prognosis
3. Rhogam does not work since already sensitized
216
Sexually active woman with green frothy malodorous discharge.
1. Diagnosis?
2. Treatment?
3. MoA?
4. ADR?
1. Trichomonas (flagellated protozoa)
2. Metronidazole
3. forms free radical metabolite to damage protozoa
4. disulfiram rxn with alcohol
217
17 year old girl that hasn't menstruated but has felt pelvic cramps every month with increasing intensity. Palpable mass anterior to rectum. Normal sex characteristics.
1. Diagnosis?
2. Pathophys?
1. Imperforate hymen
| 2. hymen blocks flow of vagina
218
Increased hCG
Increased estriol
Decreased AFP
Decreased inhibin
1. Diagnosis?
2. Complications?
1. Down Syndrome
2. Endocardial cushion defect (AV septal)
ASD
VSD
Omphalocele
219
Female infant with ambiguous genitals, hypotension, dehydration, low bicarbonate, low sodium, and high potassium.
1. Diagnosis?
2. Pathophys?
1. CAH
2. 21 hydroxylase deficiency leads to lack of aldosterone or cortisol. Accumulation of 17-hydroxyprogesterone leading to increased testosterone and virilization.
220
12 year old girl has large clitoris, no menstruation, male internal genitalia, very low DHT, and 46 XY.
1. Diagnosis?
2. pathophys?
1. 5a reductase deficiency
2. cannot convert testosterone to DHT leading to internal male but no external male characteristics. At puberty, increased testosterone leads to penis.
221
Toddler with progressive hearing loss, coarse facial features, hepatomegaly, development delay, no corneal clouding, and sulfatase deficiency.
1. Diagnosis?
2. Pathophys?
1. Hunter syndrome
- Hurlers has corneal clouding
2. x linked recessive deficiency in sulfatase leading to accumulation of mucopolysaccharides (dermatan and heparan sulfate)
