02/24/15 - Reproductive Flashcards
A 32yo African-american woman reports painful cramping during menses and periods lasting up to 10 days. Ultrasound shows multiple uterine masses. Which IHC stain should be used to confirm diagnosis on biopsy?
A. Cytokeratin
B. Desmin
C. GFAP
D. Neurofilament
E. Vimentin
B. Desmin
These are uterine fibroids (leiomyomas); they are comprised of smooth musccle which stain for desmin. Cytokeratin is for epithelium, GFAP for some neuroglia, neurofilament stains for neurons, and vimentin for connective tissue.
A 68yo man reports nocturia and difficulty starting urination. His PSA was normal, but his prostate is enlarged. What should his doctor prescribe?
A. Finasteride
B. Flutamide
C. Ketoconazole
D. Spironolactone
E. Yohimbine
A. Finasteride
This is BPH; recall that it results from the effect of DHT on the prostate. Finasteride, being a 5a-reductase inhibitor, would slow the progression of this condition.
A 3yo has a history of recurrent sinus infections. On auscultation, his heart is heard on the right side of his body. This congenital disorder could also cause him to have which of the following?
A. Defective chloride transport
B. Elevated blood sugar
C. Infertility
D. Reactive airway disease
E. Tetralogy of Fallot
C. Infertility
This is Kartagener’s syndrome; a defect in dynein results in immotile cilia leading to sinusitis, situs inversus, bronchiectasis and male infertility.
A baby is born who is small for gestational age and smells musty. The mother was consuming large amounts of diet soda. An amino acid screen notes deficiency of which of the following?
A. Cysteine
B. Glutamine
C. Phenylalanine
D. Proline
E. Tyrosine
E. Tyrosine
This is phenylketonuria; phenylalanine (from the diet soda) cannot be converted to tyrosine. The musty odor is a result of the phenylalanine accumulation.
In testicular feminization syndrome, androgens are produced but cells don’t respond to them because they lack appropriate intracellular recepotrs. What do steroids regulate the rate of after binding?
A. Protein synthesis initiation
B. mRNA degradation
C. mRNA processing
D. Protein translation
E. Gene transcription
E. Gene transcription
*This is true of all steroids, though some may have cell surface receptors as well. *
3 hours after birth, a premature infant (28weeks gestation) is in respiratory distress with RR 56, nasal flaring, and retractions. What is deficient in his lungs?
A. Angiotensin-converting enzyme
B. Collagen
C. Dipalmitoyl phosphatidylcholine
D. Elastase
E. Functional cilia
C. Dipalmitoyl phosphatidylcholine
This is neonatal respiratory distress syndrome (neonatal atelectasis); the infant has not produced adequate surfactant (from Type II pneumocytes), of which phosphatidylcholine is a component.
A newborn male has a urethral meatus opening on the ventral side of the penis. What is the cause of this malformation?
A. Failure of urethral fold fusion
B. Failure of urethrorectal septum formation
C. Maldevelopment of the urinary sphincters
D. A shortened urethra
E. A urethral stricture
A. Failure of urethral fold fusion
This is hypospadias, which results from failure of fusion of the urethral folds. Recall that the other genital precursors are the labioscrotal swelling and genital tubercle (which fails to fuse in epispadias).
A 17yo female with a history of aortic coarctation presents with Tanner stage 2 breast and pubic development, with absent menarche. Which of the following is most likely to be found?
A. Low levels of estrogen
B. Normal ovaries
C. Patent ductus arteriosus
D. Simian crease
E. 46XY karyotype
A. Low levels of estrogen
This is Turner’s syndrome; these patients exhibit streak ovaries that are not fully hormono-competent. Simian crease indicates Down syndrome. The karyotype in Turner’s is 45XO.
A 27yo female presents with a painful labial vesicle and bilateral inguinal lymphadenopathy. She is sexually active. Tzanck, VDRL, and viral-PCR are negative. What medication do you prescribe the patient?
A. Acyclovir
B. Ceftriaxone
C. Foscarnet
D. Analgesic only
E. Vancomycin
B. Ceftriaxone
This is chancroid (from Haemophilus Ducreyi), which should be treated with antibiotics that affect gram-negatives. Acyclovir and foscarnet are for viral infections. Vancomycin is ill-advised.
A teenage boy presents with a genital rash extending to the abdomen. He has numerous small, flesh colored nodules with central umbilication. What type of virus is responsible for this?
A. HSV-1
B. HHV-8
C. Poxvirus
D. Rubeola virus
E. VZV
C. Poxvirus
This is molluscum contagiosum; note the painless flesh-colored nodules. HHV-8 and Rubeolavirus do not affect the genitalia. Herpesvirus STIs are generally erythematous.
A 22yo menstruating female presents with fever, hypotension, and a diffuse macular rash. Her tampon is cultured and grows a catalase-positive, gram-positive cocci. Her rash has begun to desquamate. What is the causative organism?
A. Actinomyces israelii
B. Clostridium perfringens
C. Proteus mirabilis
D. Staphylococcus aureus
E. Streptococcus pyogenes
D. Staphylococcus aureus
This is a classic case of staph toxic shock syndrome. Strep can also cause a toxic shock but does not cause the scalded skin syndrome and is not catalase positive.
A 23yo pregnant female reports painful bumps on her genitals. Vesicles are seen on exam. Which of the following tests would indicate risk of congenital anomalies for the fetus?
A. Anti-Hep B surface antibody
B. Giemsa stain for cytoplasmic inclusions
C. Monospot test
D. Tzanck smear for multinucleated giant cells
E. Weil-felix test
D. Tzanck smear for multinucleated giant cells
Tzanck test looks for giant cells seen in CMV, HIV, and many herpesviridae. Of these, Herpes can present with painful genital lesions and is a member of TORCH. HepB does not cause congenital anomalies. Giemsa stain looks for chlamydia (no genital vesicles), monospot looks for EBV (no genital vesicles), and Weil-Felix is for typhus or Rocky mountain spotted fever.
A 70yo male with dementia is brought in for evaluation of hematuria. He has lost weight, denies pain, and shows invasive transitional cells with atypical nuclei and mitotic spindles on bladder biopsy. Which off the following risk factors has the strongest association with his disease?
A. Aniline dye exposure
B. Prior cyclophosphamide treatment
C. Heavy cigarette smoking
D. History of pelvic irradiation
E. Prior schistosomiasis infection
C. Heavy cigarette smoking
Bladder cancer is one of the many promoted by smoking. All of the other listed factors can cause bladder cancer, but pale in comparison to smoking as risk factors.
A 68yo man has difficulty with urinary frequency and hesitancy due to BPH. He says finasteride is working, and asks how the drug works. Your answer?
A. Forms superoxides that attack DNA
B. Gonadotropin releasing hormone analog
C. Inhibition of PDE-5
D. Inhibition of 5a-reductase
E. Inhibits cytochrome P450s
F. Inhibits testosterone’s negative feedback on gonadotropin secretion.
D. Inhibition of 5a-reductase
A describes bleomycin, B describes leuprolide, C describes sildenafil, E describes lots of things that aren’t finasteride (eg Ketoconazole), and F describes flutamide.
A 32yo female from Peru reports with an unplaned pregnancy. You notice that her tears are orange. Her OCP was less effective due to an interaction with treatment for which of the following?
A. Breast cancer
B. Epilepsy
C. Giardia
D. Refractory A-fib
E. Tuberculosis
E. Tuberculosis
Orange body fluids are a notable side effect of Rifampin, which is one of the 3-5 drugs used to treat tuberculosis. It is also a P450 inducer.
A patient is experiencing hot flashes and is considering hormone replacement therapy. What other benefits may it confer?
A. Decrease risk of breast cancer
B. Decrease risk of DVT
C. Decrease risk of hip fractures
D. Decrease risk of heart attacks
E. Decrease risk of strokes
C. Decrease risk of hip fractures
Estrogen HRT is effective in treating vasomotor symptoms and preventing osteoporosis. It probably increases CV events, and may increase risk of breast cancer.
