Rx_1.29 (Reproductive) Flashcards Preview

USMLE Step 1 > Rx_1.29 (Reproductive) > Flashcards

Flashcards in Rx_1.29 (Reproductive) Deck (13)
Loading flashcards...
1

Drugs used in medical abortion

  1. mifepristone = progesterone antagonist
    1. ==> uninhabitable/unsustainable uterine environment for fetus
  2. misoprostol (taken a few days after mifepristone) = prostaglandin E1 analog 
    1. ==> uterine contraction and expulsion of fetal remnants

2

Most important risk factor for development of cervical cancer

  • most important = early onset of sexual activity
  • others
    • multiple sexual partners
    • smoking 
    • low socioeconomic status
  • association with high risk HPV virus (16, 18)

3

Congenital Adrenal Hyperplasia presentation/mechanism

  • 21-alpha-hydroxylase deficiency ==> failure to produce aldosterone and cortixol + (shuttling of intermediates =>) increased androgen production
  • ambigous genitalia
  • hypotension
  • hypovolemia
  • hyperkalemia

4

Adrenal steroid synthesis pathways

  • Aldosterone (Salt) [@ Zona Glomerulosa]
    • Chlosterol ==> Pregnenolone ==> Progesterone ==(21a-hydroxylase)==> 11-deoxycorticosterone ==(11B-hydroxylase)==> corticosterone ==> aldosterone
  • Cortisol (Sugar) [@ Zona fasciculata]
    • Chlosterol ==> Pregnenolone ==(17a-hydroxylase)==> 17-hydroxypregnenlolone ==> 17-hydroxyprogesterone OR

    • Progesterone ==(17a-hydroxylase)==> 17-hydroxyprogesterone ==(21a-hydroxylase)==> 11-deoxycortisol ==(11B-hydroxylase)==> cortisol

  • Androgens (Sex) [@ Zona Reticularis]

    • Chlosterol ==> Pregnenolone ==(17a-hydroxylase)==> 17-hydroxypregnenlolone ==> DHEA ==> Androstenedione ==> Testosterone

      • Androstenedione ==(aromatase)==> estrone

    • Progesterone ==(17a-hydroxylase)==> 17-hydroxyprogesterone ==> Androstenedione ==> Testosterone

    • Testosterone ==(aromatase)==> estradiol

    • Testosterone ==(5a-reductase)==> DHT (dihydrotestosterone)

5

Presentation of intraductal papilloma

  • = tumor of lactiferous ducts
  • presents w/bloody discharge from nipple (most common cause)

6

Mastitis presentation

  • associated w/breastfeeding
  • chronic mastitis can occur @ postmenopausal women due to inflammation of ducts beneath nipple
  • presentation
    • breast erythema, engorgement, tenderness
    • fever, chills

7

Cardinal ligament location/significance

  • located @ base of broad ligaments 
  • contain the uterine arteries and veins
    • internal iliac ==> uterine artery ==> uterus

8

Location of ovarian arteries

Within infundibulopelvic ligament (aka suspensory ligament of the ovaries)

9

Histologic quality of endometrium during the menstrual cycle

  • proliferative phase = estrogen driven
  • secretory phase = progesterone driven

10

Location of sperm development/genetic content at various locations

  • sperm develop from the outside of the tubule inward
    • spermatogonium (2N) = @ basal side
    • spermatid (N) = @ apical-side
  • spermatocytes (4N) = slightly more apical than spermatogonium

11

Presentation/Tx of PID 

  • Presentation
    • purulent vaginal discharge
    • lower abdominal pain
    • fever
    • cervical motion tenderness
    • [often hx of unprotected sex]
  • Tx
    • Certriaxone ==> gonorrhea
    • Azithromycin ==> chlamydia 

12

Presentation of 5a-reductase deficiency

  • genotypic male born w/ambigous genitalia
    • male internal gneitalia
    • ambiguous/female-appearing external genitalia
    • most raised as girls
  • puberty ==> increased testosterone ==> masculinization of external genitalia
    • "penis-at-12" phenomenon
  • LH and Testosterone levels elevated
  • 5a-reductase: converts T ==> dihydrotestosterone (DHT) = necessary for normal development of male external genitalia in utero

13

Tamsulocin: MOA

Phenasteride: MOA

  • Tamsulocin = alpha-1 antagonist

Decks in USMLE Step 1 Class (97):