Study guide & Fellow review

Question 1

AMH is AKA __

Answer 1

mullerian inhibiting substance (MIS)

Question 2

Mullerian duct becomes:

Answer 2

tubes, uterus, upper 1/3 vagina

Question 3

Wolffian duct becomes:

Answer 3

epididymus, vas deferens, seminal vesicles

Question 4

What does Mullerian NOT become?

Answer 4

ovaries, lower vagina, clitoris

Question 5

What does Wolffian duct NOT become?

Answer 5

testes, penis

Question 6

main 2 ddx for absence of uterus

Answer 6

mullian agenesis, androgen insensitivity

Question 7

What do sertoli cells produce

Answer 7

MIS

Question 8

What do Leydig cells produce

Answer 8

testosterone

Question 9

Swyers syndrome

Answer 9

XY, mutation in SRY gene, phenotypically female

Question 10

Gonads in Swyers?

Answer 10

streak

Question 11

androgen insensitvity

Answer 11

female phenotype but no ovaries, scant pubic hair, breast development (aromatization from T), male T level

Question 12

Defect in MRKH

Answer 12

mutation in AMH gene or receptor

Question 13

heritability of 5 alpha reductase deficiency

Answer 13

autosomal recessive

Question 14

which DSD most likely to have gender dysphoria

Answer 14

5-ARD (grow penis at puberty)

Question 15

What test do your order to r/o CAH

Answer 15

17-ohp

Question 16

order of female puberty

Answer 16

breast (thelarche), pubic hair (adrelarchy), growth spurt,

menarche, (“TAG-men”)

Question 17

When should menses occur by? (define delayed puberty)

Answer 17

13 w/o breast, 15 if secondary sex

Question 18

short stature, webbed neck, shield chest, streak gonads

Answer 18

Turner’s

Question 19

precocious puberty, cafe au lait spots, increased bone age

Answer 19

McCune Albright (upstream production of estrogen due to G protein mutations)

Question 20

treatment for McCune Albright

Answer 20

aromatase inhibitors - testalactone (shut down production of estradiol)

Question 21

definition of precocious puberty in girls

Answer 21

under 6 in black, under 7 in white

Question 22

Can put precocious puberty kids on __ to prevent early growth plate fusing

Answer 22

lupron

Question 23

Why do GnRH agonists & antagonists work to prevent LH/FSH secretion?

Answer 23

activation requires pulsatile action

Question 24

How to improve IVF success with hydrosalpinx?

Answer 24

salpingectomy or occlude tubes before IVF

Question 25

treatment for labial adhesion

Answer 25

estrogen cream (NOT surgical)

Question 26

What vaccine do you NOT GET within 3 weeks before IVF

Answer 26

MMR (bc contraindicated in pregnancy)

Question 27

What infectious disease does treating BV help prevent?

Answer 27

STDs, including HIV

Question 28

22 yo w primary ovarian insufficiency w/ bone fractures, considering pregnancy, how to treat osteoporosis?

Answer 28

hormone replacement (don't forget calcium, vitamin D)

Question 29

mutations associated with lynch syndrome

Answer 29

MLH1, PMS2, MSH2, MSH6 - microsatellite instability, germ line mutation in DNA mismatch repair gene

Question 30

most common presentation of fallopian tube carcinoma

Answer 30

postmenopausal bleeding or copious clear discharge

Question 31

male to female transition at most risk of what disease?

Answer 31

pro-thrombotic -- hyperlipidemia, PE

Question 32

During HSG you see b/l distal occlusion, what do you do?

Answer 32

Give doxycycline x5 days

Question 33

risk for SCD in pregnancy

Answer 33

anemia - can't increase RBC mass as normal

Question 34

HPV type most at risk for adenocarcinoma of cervix

Answer 34

18

Question 35

If BV and has allergey to flagyl, what med?

Answer 35

intravaginal clindamycin

Question 36

NIPT cell free DNA comes from what source?

Answer 36

trophoblasts

Question 37

Peak bone mass is determined by:

Answer 37

genetics

Question 38

why don't we see ovarian hyperstimulation syndrome anymore

Answer 38

use lupron trigger now instead of hcg

Question 39

In a hypo hypo patient how to do ovulation induction?

Answer 39

FSH

Question 40

how does clomiphene work

Answer 40

SERM

Question 41

how does letrozole work

Answer 41

shuts down aromatization, body thinks no estrogen

Question 42

PCOS ovulation induction

Answer 42

letrozole

Question 43

How does estrogen increase bone density

Answer 43

inhibits osteoclasts

Question 44

changes after menopause (up, down, same): T, androstenedione, SHBG, estradiol, estrone

Answer 44

T: down androstenedione: down SHBG (sex hormone binding globulin): down - so can have increased free E & T estradiol: down estrone: down (but relative proportion is higher)

Question 45

most success for fertility protocol: mature oocyte, immature, oocyte, tissue cryo?

Answer 45

mature oocyte

Question 46

incidence of CF highest in what ethnic group

Answer 46

white

Question 47

most common mutation in CF

Answer 47

delta F508

Question 48

age to start DXA scan

Answer 48

65

Question 49

CAH how inherited? What gene?

Answer 49

autosomal recessive, CYP2...

Question 50

what is associated with mild hyperprolactinemia?

Answer 50

endometriosis

Question 51

subfascial hematoma after myomectomy - what artery injured?

Answer 51

inferior epigastric artery

Question 52

normal cysto after surgery but found to be damaged later - why?

Answer 52

thermal spread

Question 53

How to differentiate theca lutein cysts vs luteomas

Answer 53

theca lutein cysts bilateral (result of HCG - twin pregnancy, molar pregnancy) luteoma usually unilateral

Question 54

What is the ethical appeal behind no longer assigning female gender with surgery in the setting of ambiguous genitalia at birth? (autonomy, justice, beneficence, non maleficence)

Answer 54

autonomy

Question 55

first lab to get in workup of acromegaly?

Answer 55

IGF1

Question 56

buzzword: imprinting disorder in context of artificial reproductive technology

Answer 56

ICSI

Question 57

examples of imprinting disorder

Answer 57

Prader willi, angelman

Question 58

when do mono mono twins separate?

Answer 58

8-13 days (1-2 weeks)

Question 59

AGC on pap, normal colpo, normal ECC, normal EMB, next step?

Answer 59

cotest 12 months, but we think D&C

Question 60

infectious risk highest w what osteoporosis med

Answer 60

denosumab (skin infections & eczema)

Question 61

osteoprosis med with concern for renal damage

Answer 61

zoledronic acid

Question 62

most common bug in pyelo

Answer 62

E coli

Question 63

breast cancer with dermal ducts, what type

Answer 63

inflammatory breast cancer

Question 64

pt with endometrial hyperplasia, what type of hyst do you recommend?

Answer 64

vag hyst

Question 65

split in di-di twins?

Answer 65

0-3 days

Question 66

what kind of breast cancer has peritoneal implants?

Answer 66

lobular invasive

Question 67

what is receptor status of brca1-2 related breast cancer?

Answer 67

triple negative

Question 68

treatment of choice for pt with twin twin transufation

Answer 68

laser

Question 69

Is toxic shock due to endo or exo toxin?

Answer 69

strep pyogenes exotoxins

Question 70

paclitaxel MOA

Answer 70

stabilize microtubules

Question 71

which is most sensitive to radiation? (large bowel, small bowel, bladder)

Answer 71

small bowel

Question 72

MOA immiquimod

Answer 72

immune modulate

Question 73

if get sued new or old company or you pays?

Answer 73

old company if you have tail insurance

Question 74

Pt hasn't seen you in 5 years

Answer 74

bill as new pt

Question 75

blueberry muffin rash

Answer 75

CMV

Question 76

CMV avidity testing reveals both IgM, IgG positive with high avidity - immune, acute, chronic?

Answer 76

re-infection w different strain or reactivation

Question 77

Who put together national practitioner database?

Answer 77

Congress

Question 78

safest hypnotic in elderly? (ativan, xanax, valium, ambien)

Answer 78

avoid benzos!

Question 79

cervical cancer marker p53? RB

Answer 79

E6 inactivates p53 | E7 inactivate Rb

Question 80

what causes elevated tryptase levels?

Answer 80

allergic reaction