Rx_1.26 (Reproductive) Flashcards Preview

USMLE Step 1 > Rx_1.26 (Reproductive) > Flashcards

Flashcards in Rx_1.26 (Reproductive) Deck (28)
1

Ringworm (tinea corpis) tx + MOA + SE

  • ketoconazole
  • MOA = blocks formation of fungal membrane sterols
  • SE = endocrine effects
    • blocks CYP450scc/desmolase = necc. for testerone and cortisol from cholesterol
    • decreased cortisol ==> decreased inhibition of POMC ==> increased synth of ACTH, melanocyte-stimulating hormone, endorphins ==> skin darkening

2

Penile venous outflow abnormalities ==>

  • erectile dysfxn
  • normal = blood flow accelerates into corpus cavernosum ==> blockage of venous outflow ==> erection
  • abnormalities usually due to insufficient relation of smooth m. from excess adrenergic tone or damaged parasympathetic
  • leak from dorsal vein ==> saphenous vein ==> inability to maintain erection

3

Normal vaginal pH

3.8-4.5

4

Vaginitis w/vulvar pruritis + discharge + [image] ==> Dx? 

vulvovaginal candidiasis

5

Common vaginal infections and impact on vaginal pH

  • candida = normal pH (<4.5)
  • bacterial vaginosis ==> 5.0 - 6.0
  • trichomonas ==> 5.0-7.0
  • vaginal pH = 8.0 ==> suspicious for contamination w/cervical mucus or sperm

6

Neonate w/hepatosplenomegaly, ascites, peripheral edema, purpura ==> dx?

  • hydrops fetalis = consequence of severe hemolytic disease of the newborn
  • mechanism: 
    • Rh-negative mother w/previous Rh-positive child ==> sensitization 
    • if next child = Rh-positive ==> maternal IgG crosses placenta attacks fetal RBCs

7

Characteristics of seminoma

  • most common testicular neoplasm
  • common @ 15-35yo
  • painless presenation
  • radiosensitive
  • pathology = 
    • large cells in lobules w/watery cytoplasm
    • "fried egg" appearance

8

testicular mass w/glandular/papillary morphological pattern ==> dx?

  • embryonal carcinoma
  • [usually painful]   

9

cowdry type A nuclear inclusions ==> dx?

CMV infection

10

testicular mass w/Reinke's crystals ==> dx?

  • Leydig's cell tumors
  • usually produce androgens ==> gynecomastia in men or precocious puberty in boys
  • non-germ cell tumor

11

testicular mass w/structures resembling primitive glomeruli ==> dx?

  • yolk sac tumors
  • "schiller-duval bodies" = structures resembling primitive glomeruli

12

Structure of cilia + common defect

  • central pair of microtubules w/ nin surrounding pairs w/dynein arms that create "sweeping motion"
  • dynein defect ==> Kartagener's syndrome
    • poor mucous clearance ==> chronic sinus infections
    • infertility
    • assoc. w/situs inversus

13

Normal vaginal flora + fxn

  • lactobacilli = gram-positive facultative anaerobes
    • help maintain acidic vaginal pH (3.5-4.2)
    • loss of bacteria (e.g. during a course of antibiotic tx) ==> slight increase in vaginal pH ==> growth of candida (yeast infection)

14

Pharm tx for HER2 (human epidermal growth factor) breast cancer cells 

  • Trastuzumab = monoclonal antibody agains HER2

15

Tamoxifen use

  • chemotherapeutic agent @ estrogen receptor-positive breast cancer
  • selective antagonist ==> inhibition of production of estrogen-responsive genes

16

Common lymphatic spread of testicular tumors

==> paraaortic chain of lymph nodes

17

Components of male urethra

  • prostatic urethra (runs through prostate)
  • membranous urethra (runs through urogeneital diaphragm)
  • penile urethra (runs through penis)

18

consequences of rupture of urethra below the urogenital diaphragm (males)

  • rupture @ jxn of membranous and penile urethra ==> urine into scrotum and perineal region
  • "straddle injury"

19

Characteristics of fibroadenomas

  • most common breast mass in young women
  • histologic appearance
    • fibrosing interlobular stroma around normal duct and gland architecture

20

Large cells w/clear "halos" on breast biopsy ==> dx?

Paget disease = eczematous skin findings around nipple associated w/underlying ductal carcinomas

21

Branching fibrovascular core extending from a dilated duct on breast biopsy ==> dx?

  • intraductal papilloma = benign solitary lesions that line lactiferous ducts
  • ==> serosanguinous (serous fluid or blood) and unilateral nipple discharge

22

Parallel arrays of small, monomorphic cells w/scant cytoplams on breast biopsy ==> dx?

  • infiltrating lobular carcinoma
  • irregular mass on palpation
  • common @ postmenopausal women

23

Sheets of pleomorphic cells infiltrating adjacent stroma on breast biopsy ==> dx?

  • invasive ductal carcinoma = most common mass in older women
  • ==> overlying skin changes; e.g. pigmented dimpling or unilateral bloody nipple discharge
  • palpation = firm, irregular, fixed masses
  • mammography = multiple small calcifications

24

Presentation of congenital adrenal hyperplasia

  • 21-hydroxylase deficiency ==>
    • inability to convert steroid precursors to aldosterone or cortisol
  • excess substrate ==> androgen production ==>
    • ambigous (virilized) genitals 
  • low aldosterone/cortisol ==>
    • renal salt wasting (hyponatremia)
    • hypotension
    • hyperkalemia

25

Substrate of 21-hydroxylase

  • 17-hydroxyprogesterone <== will build up in 21-hydroxylase deficiency

26

Ovarian biopsy ==> Dx?

  • Brenner's tumor = benign ovarian tumor composed of cells resembling bladder transitional epithelium

27

Edward's syndrome (Trisomy 18): AFP, B-HCG, estriol, inhibin A

  • AFP = low
  • B-HCG = low
  • estriol = low
  • inhibin A = normal

28

Patau syndrome (Trisomy 13): AFP, B-HCG, estriol, inhibin A

  • AFP = normal
  • B-HCG = normal
  • estriol = normal
  • inhibin A = normal

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