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Dr. Wall's Board Review Course > 5 Star Study Guide > Flashcards

5 Star Study Guide Flashcards

1
Q

Which antibodies cause severe HDFN?

A

Anti-RhD; Anti-RhE; Anti-Kell (K1); Anti-Rhc

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2
Q

Which antibodies do not cause hemolytic disease?

A

LEWIS, l, Duffy (Fyb)

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3
Q

What is aneuploidy risk by maternal age (30, 35, 40, 45) for Down’s syndrome vs any chromosomal abnormality?

A

30: 1/1000 v 1/500
35: 1/365 v 1/180
40: 1/100 v 1/50
45: 1/36 v 1/18
(remember to cut the Down’s value in half)

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4
Q

When should you complete the nuchal translucency?

A

Between 11w0d and 13w6d

[CRL between 45 and 84mm]

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5
Q

Greater than what value for a nuchal translucency warrants further evaluation?

A

> 3mm

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6
Q

A large nuchal translucency is associated with what?

A

Down’s syndrome, Trisomy 18, Congenital heart disease/cardiac malformation (most commonly associated)

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7
Q

What crosses the placenta by simple diffusion?

A

Oxygen, CO2, electrolytes, ketones

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8
Q

What crosses the placenta by active transport?

A

Amino acids, calcium, phosphorous, iron

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9
Q

What crosses the placenta by facilitated diffusion?

A

Glucose, sucrose, fructose

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10
Q

What crosses the placenta by endocytosis?

A

IgG

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11
Q

What crosses the placenta by bulk flow?

A

Water

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12
Q

What crosses the placenta with carrier mediated transport?

A

Iodine

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13
Q

True or false: PTU crosses the placenta?

A

True

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14
Q

True or false: TRH crosses the placenta?

A

True

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15
Q

True or false: Iodine crosses the placenta?

A

True

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16
Q

True or false: Magnesium sulfate crosses the placenta?

A

True

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17
Q

True or false: long-acting thyroid stimulator crosses the placenta?

A

True. LATS is thought to be responsible for the hyperthyroidism in Graves disease

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18
Q

True or false: IgG crosses the placenta?

A

True

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19
Q

True or false: Propanalol crosses the placenta?

A

True

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20
Q

True or false: T3 crosses the placenta?

A

True

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21
Q

True or false: T4 crosses the placenta?

A

True

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22
Q

True or false: Heparin crosses the placenta?

A

False

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23
Q

True or false: Insulin crosses the placenta?

A

False

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24
Q

True or false: TSH crosses the placenta?

A

False

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25
Q

Increase, decrease, or no change during pregnancy?

Heart Rate

A

Increase

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26
Q

Increase, decrease, or no change during pregnancy?

Cardiac Output

A

Increase

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27
Q

Increase, decrease, or no change during pregnancy?

Plasma Volume

A

Increase

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28
Q

Increase, decrease, or no change during pregnancy?

Red Cell volume

A

Increase

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29
Q

Increase, decrease, or no change during pregnancy?

GFR

A

Increase

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30
Q

Increase, decrease, or no change during pregnancy?

Systemic Vascular Resistance

A

Decrease

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31
Q

Increase, decrease, or no change during pregnancy?

CO2

A

Decrease

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32
Q 
Increase, decrease, or no change during pregnancy?
Respiratory Volume (aka lung volume)
A

Decrease

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33
Q

Increase, decrease, or no change during pregnancy?

Total thyroxine

A

Increase (total T4)

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34
Q

Increase, decrease, or no change during pregnancy?

Total triiodothyronine

A

Increase (Total T3)

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35
Q

Increase, decrease, or no change during pregnancy?

Thyroxine binding globulin

A

increase

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36
Q

Increase, decrease, or no change during pregnancy?

PTH

A

Increase

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37
Q

Increase, decrease, or no change during pregnancy?

Prolactin

A

Increase

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38
Q

Increase, decrease, or no change during pregnancy?

Prostacyclin (aka Prostaglandin I2)

A

Increase.

Inhibits platelet aggregation and causes vasodilation

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39
Q

Increase, decrease, or no change during pregnancy?

Thromboxane

A

Increases

Causes blood clotting and vasoconstriction

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40
Q

Increase, decrease, or no change during pregnancy?

Cholesterol

A

Increases

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41
Q

Increase, decrease, or no change during pregnancy?

ESR

A

Increases

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42
Q

Increase, decrease, or no change during pregnancy?

Plasma fibrinogen

A

Increases

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43
Q

Increase, decrease, or no change during pregnancy?

Hemoglobin/hematocrit

A

Decreases

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44
Q

Increase, decrease, or no change during pregnancy?

Creatinine

A

Decreases

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45
Q

Increase, decrease, or no change during pregnancy?

BUN

A

Decreases

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46
Q

Increase, decrease, or no change during pregnancy?

Total serum calcium

A

Decreases

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47
Q

Effect of progesterone (increase or decrease) on appetite?

A

Increase

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48
Q

Effect of progesterone (increase or decrease) on minute ventilation?

A

Increase

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49
Q

Effect of progesterone (increase or decrease) on body temperature?

A

Increase

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50
Q

Effect of progesterone (increase or decrease) on nasal congestion?

A

Increase

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51
Q

Effect of progesterone (increase or decrease) on LDL?

A

Increase

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52
Q

Effect of progesterone (increase or decrease) on depression?

A

Increase

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53
Q

Effect of progesterone (increase or decrease) on tubal mobility?

A

decrease

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54
Q

Effect of progesterone (increase or decrease) on lining on the uterus

A

decrease (thin)

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55
Q

Effect of progesterone (increase or decrease) on ureteral mobility?

A

Decrease

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56
Q

Effect of progesterone (increase or decrease) on esophageal sphincter tone?

A

Decrease

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57
Q

Effect of progesterone (increase or decrease) on HDL?

A

Decrease

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58
Q

Increase, decrease, or no change during pregnancy?

Residual volume

A

Decrease

Amount of air that remains in a person’s lung after fully exhaling

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59
Q

Increase, decrease, or no change during pregnancy?

Expiratory reserve volume

A

Decrease

The amount of extra air exhaled during a forceful breath out

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60
Q

Increase, decrease, or no change during pregnancy?

Total lung capacity

A

Decrease

Maximum amount of air your lungs can hold

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61
Q

Increase, decrease, or no change during pregnancy?

Functional residual capacity

A

Decreases

Volume remaining in lungs after normal, passive, exhale

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62
Q

Increase, decrease, or no change during pregnancy?

Inspiratory capacity

A

Increases

Maximum volume of air that can be inspired after a normal, quiet expiration

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63
Q

Increase, decrease, or no change during pregnancy?

Tidal volume

A

Increases

Amount of air that moves in and out with each breath

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64
Q

Increase, decrease, or no change during pregnancy?

Vital capacity

A

No change

Greatest amount of air that can be expelled from the lungs after taking the deepest possible breath

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65
Q

Increase, decrease, or no change during pregnancy?

Inspiratory reserve volume

A

No change

The volume of air a person can inhale after a normal inhalation

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66
Q

Increase, decrease, or no change during pregnancy?

Factor 1

A

Increase
Factor 1 is fibrinogen
Procoagulant

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67
Q

Increase, decrease, or no change during pregnancy?

Factor 7

A

Increase

Procoagulant

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68
Q

Increase, decrease, or no change during pregnancy?

Factor 8

A

Increase

Procoagulant

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69
Q

Increase, decrease, or no change during pregnancy?

Factor 10

A

Increase

Procoagulant

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70
Q

Increase, decrease, or no change during pregnancy?

Von Willebrand Factor

A

Increase

Procoagulant

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71
Q

Increase, decrease, or no change during pregnancy?

Plasminogen activator inhibitor 1 (PAI-1)

A

Increases.
One of the most important inhibitors of the plasma fibrinolytic activity; rapid acting
Procoagulant

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72
Q

Increase, decrease, or no change during pregnancy?

Plasminogen Activator Inhibitor 2 (PAI-2)

A

Increases

Procoagulant

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73
Q

Increase, decrease, or no change during pregnancy?

Factor 11

A

Decrease

Procoagulant

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74
Q

Increase, decrease, or no change during pregnancy?

Factor 13

A

Decrease

Procoagulant

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75
Q

Increase, decrease, or no change during pregnancy?

Factor 2

A

No change

Procoagulant

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76
Q

Increase, decrease, or no change during pregnancy?

Factor 5

A

No change

Procoagulant

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77
Q

Increase, decrease, or no change during pregnancy?

Factor 9

A

No change

Procoagulant

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78
Q

Increase, decrease, or no change during pregnancy?

Protein S

A

Decreases (actual number increases by trimester, overall still decreased)
Anticoagulant

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79
Q

Increase, decrease, or no change during pregnancy?

Protein C

A

No Change

Anticoagulant

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80
Q

Increase, decrease, or no change during pregnancy?

Anti thrombin 3

A

No change

Anticoagulant

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81
Q

Increase, decrease, or no change during pregnancy?

T4

A

Increase

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82
Q

Increase, decrease, or no change during pregnancy?

Iodide

A

Decrease

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83
Q

Increase, decrease, or no change during pregnancy?

Free T4

A

No change

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84
Q

Increase, decrease, or no change during pregnancy?

TSH

A

No change (does decrease slightly in the first 10 weeks d/t bHCG)

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85
Q

What hyperthyroid medication should you use in the first trimester?

A

PTU

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86
Q

What hyperthyroid medication should you use in the 2nd and 3rd trimesters?

A

Methimazole

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87
Q

What teratogenic effect is seen with methimazole?

A

Aplasia cutis (congenital lack of skin, most commonly on scalp)

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88
Q

Which antithyroid drug is known to cause agranulocytosis?

A

Both PTU and methimazole

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89
Q

Why do we restrict use of PTU in pregnancy?

A

Risk of hepatotoxicity. Only use in the first trimester

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90
Q

What is the limiting pelvic dimension for vaginal delivery?

A

Ischial spines (mid pelvis)

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91
Q

What is the average bispinous diameter in women?

A

10.5cm

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92
Q

What is the diagonal conjugate?

A

The symphysis pubis to the sacral promontory

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93
Q

Which conjugate (true, obstetric, diagonal) is the shortest?

A

Obstetric

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94
Q

Which conjugate (true, obstetric, diagonal) can be clinically assessed?

A

Diagonal

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95
Q

How do you estimate the obstetric conjugate?

A

Diagonal conjugate - 1.5cm

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96
Q

What is the definition of a contracted obstetrical conjugate?

A

< 10.5cm

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97
Q

What is the average biparietal diameter at term?

A

9.3cm

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98
Q

What is the average femur length at term?

A

7.4cm

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99
Q

What is the definition of engagement?

A

The BPD passed the plane of the inlet. Presenting part is at the ischial spines

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100
Q

What is the best pelvic shape for vaginal birth?

A

Gynecoid

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101
Q

What pelvic shape is associated with increased OP delivery?

A

Anthropoid

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102
Q

What pelvic shape is associated with persistent transverse presentation?

A

Platypelloid

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103
Q

What pelvic shape is the worst for vaginal delivery?

A

Android

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104
Q

What fraction of twins are dizygous?

A

2/3

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105
Q

What fraction of monozygous twins are mono-di?

A

2/3

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106
Q

What fraction of twins (excluding mono-mono) can be delivered vaginally?

A

2/3 (40% vertex/vertex, 25% vertex/breech)

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107
Q

How do you calculate growth discordance?

A

(EFW large - EFW small)/EFW large

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108
Q

During what days after fertilization would a split lead to di-di twins?

A

0-3 days

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109
Q

During what days after fertilization would a split lead to mono-di twins?

A

4-8 days

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110
Q

During what days after fertilization would a split lead to mono-mono twins?

A

9-12 days

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111
Q

How many days after fertilization would a split lead to conjoined days?

A

13 + days

112
Q

What is the most common type of conjoined twins?

A

Thoracophagus

113
Q

What % of twins are dizygous vs monozygous?

A

66% dizygous, 33% monozygous

114
Q

What is the breakdown of di-di, mono-di, mono-mono, and conjoined from a monozygous twin pregnancy?

A

1/3 di-di; 2/3, mono-di; <1% mono-mono; <1% conjoined

115
Q

In terms of maternal mortality, what cardiac issues are low risk (Mortality < 1%)?

A

ASD, VSD, PDA, pulmonic/tricuspid diseases, corrected tetralogy of Fallot, porcine valve, mitral stenosis (NYHA classes 1 and 2)

116
Q

In terms of maternal mortality, what cardiac issues have moderate risk (mortality 5-15%)?

A

Mitral stenosis w/ a fib, artificial valve, mitral stenosis (NYHA class 3 and 4), aortic stenosis, coarctation of the aorta (uncomplicated), uncorrected tetralogy of Fallot, previous myocardial infarction, Marfan syndrome with normal aorta

117
Q

In terms of maternal mortality, what cardiac issues are high risk (mortality 25-50%)?

A

Pulmonary HTN, Coarctation of the aorta (complicated), Eisenmenger syndrome, Marfan syndrome with aortic involvement (>4cm)

118
Q

In the US what are the top causes of maternal death (with %)?

A 
CV 14.6%
Infection 13.6%
Cardiomyopathy 12%
Hemorrhage 10%
Preeclampsia 9.4%
Thromboembolism 9.3%
119
Q

How many mg of iron are required for an entire pregnancy?

A

1,000mg (an increase of 800mg from non pregnant persons)

120
Q

How much elemental iron is in, and how much is absorbed from, 325mg ferrous sulfate (oral preparation)?

A

65mg elemental iron. 6.5mg gets absorbed.

121
Q

What are the diagnostic criteria for peripartum cardiomyopathy?

A
  1. Must develop in the last month of pregnancy or within 5 months postpartum
  2. EF determined by echo to be <45%
  3. No other cause for heart failure with reduced EF found
122
Q

What is the most common cited cause of peripartum cardiomyopathy?

A

Myocarditis

123
Q

What is the mortality rate within 2 years of diagnosis of peripartum cardiomyopathy?

A

10%

124
Q

What is the treatment for peripartum cardiomyopathy?

A

Diuretics to decrease preload
Hydralazine to decrease afterload (peripheral vasculature) [alone or with nitrates]
Digoxin for inotropic effects (unless complex arrhythmia identified)
Heparin or anticoagulation strongly advised for increased risk of VTE

125
Q

What % of women diagnosed with peripartum cardiomyopathy with regain ventricular function within 6 months?

A

~50%. Portends good prognosis

126
Q

What are poor prognostic factors for peripartum cardiomyopathy?

A

Black race, age > 35-40yrs, LVEF < 25%

127
Q

What is the inheritance pattern of Marfan’s?

A

Autosomal Dominant

128
Q

What is the inheritance pattern of Neurofibromatosis?

A

Autosomal dominant

129
Q

What is the inheritance pattern of Huntingtons Chorea?

A

autosomal dominant

130
Q

What is the inheritance pattern of Von Willebrand’s disease?

A

Autosomal dominant

131
Q

What is the inheritance pattern of polycystic kidney disease with adult onset?

A

autosomal dominant

132
Q

What is the inheritance pattern of PKU?

A

autosomal recessive

133
Q

What is the inheritance pattern of congenital adrenal hyperplasia?

A

autosomal recessive

134
Q

What is the inheritance pattern of thalassemias?

A

autosomal recessive

135
Q

What is the inheritance pattern of cystic fibrosis?

A

autosomal recessive

136
Q

What is the inheritance pattern of galactosemia?

A

autosomal recessive

137
Q

What is the inheritance pattern of Tay Sachs?

A

autosomal recessive

138
Q

What is the inheritance pattern of mucopolysaccharidosis?

A

autosomal recessive

139
Q

What is the inheritance pattern of diabetes insipidus?

A

can be x-linked, can be autosomal dominant, can be autosomal recessive.

140
Q

What is the inheritance pattern of hemophilia?

A

X linked recessive

141
Q

What is the inheritance pattern of muscular dystophy?

A

X-linked recessive

142
Q

What is the inheritance pattern of testicular feminization (aka androgen insensitivity syndrome)?

A

X linked

143
Q

What is the inheritance pattern of neural tube defects?

A

Multifactorial

144
Q

What is the inheritance pattern of mullerian agenesis?

A

multifactorial

145
Q

What is the recurrence rate (with same parents) after one child is born with an autosomal dominant condition?

A

50%

146
Q

What is the recurrence rate (with same parents) after one child is born with an autosomal recessive condition?

A

25%

147
Q

What is the recurrence rate (with same parents) after one child is born with a multifactorial condition (eg spina bifida, congenital heart disease, mullerian agenesis, etc)?

A

~3-5%

148
Q

What is the recurrence rate (with same parents) after one child is born a chromosomal error (eg trisomy 21, turners)?

A

1%

149
Q

What features are associated with Edwards syndrome (trisomy 18)?

A

Small for gestational age, 2 vessel cord, short sternum, overlapping clenched fingers, rocker bottom feet

150
Q

What findings are associated with Patau syndrome (trisomy 13)?

A

Small for gestational age, facial clefts, ocular anomalies, and polydactly

151
Q

What findings are associated with cri-du-chat (chromosome 5 p deletion)?

A

High pitched cry, epicanthal fold, mental retardation

152
Q

What are the findings associated with Turner’s syndrome?

A

Short stature, web neck (cystic hygroma), pigmented nevi, low posterior hairline, trouble hearing (high arched palate), normal IQ, wide spaced nipples, increased carrying walk (omar’s walk), shield chest, streak gonads, coarctation of the aorta, renal anomalies

153
Q

What is associated with high MSAFP?

A 
Open neural tube defects
Ventral wall defects
Cystic hygroma, congenital nephrosis
Twins
Fetal death (can also have low MSAFP)
Osteogenesis imperfecta
Increased risk for: Preeclampsia, FGR, placental abruption, preterm delivery, fetal loss
154
Q

What is associated with low MSAFP?

A 
Chromosomal trisomies (13, 18, 21)
Gestational trophoblastic disease
Fetal death (Can also be associated with high MSAFP)
Overestimated gestational age
Increased maternal weight
155
Q

What conditions are associated with cystic hygroma?

A

Fetal hydrops, Turner’s syndrome, Noonan syndrome

156
Q

How do you calculated weight-based insulin in pregnancy?

A

Multiplier for insulin based off trimester (increases with each trimester).
2/3 insulin in AM, 1/3 in PM
In AM: 2/3 long-acting insulin, 1/3 short-acting
In PM: 1/2 long-acting, 1/2 short-acting

157
Q

What are the cardinal movements of labor?

A

Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

158
Q

What are the number of oocytes by age (20wk gestation, term birth, puberty, after 50)?

A

20w gestation: 6-7 million
Term birth: 1-2 million
Puberty: 500,000
After 50: 1,000

159
Q

What is the maximum Bishop score?

A

13

160
Q

What does APGAR stand for?

A

Activity (tone), Pulse (HR), Grimace (reflex irritability), appearance (color), Respirations

161
Q

What nerve roots are injured in Erb’s palsy?

A

C5-6

162
Q

What muscles are effected in Erb’s palsy?

A

Deltoid, infraspinatus, forearm flexor

163
Q

Is Erb’s palsy or Klumpke’s palsy more common?

A

Erb’s palsy

164
Q

What nerve roots are effected in Klumpke’s palsy?

A

C8-T1

165
Q

What % of infants with a brachial plexus injury are left with significant residual deficits?

A

15%

166
Q

What are the most common sequelae of vacuum assisted vaginal deliveries (to the newborn)?

A

Hyperbilirubinemia (most common d/t increased risk of cephalohematoma), scalp laceration (33%), cephalohematoma (16%), subgaleal hematoma (3%, most lethal)

167
Q

What is the C section rate in the US?

A

31.8%

168
Q

What is the most common indication for a cesarean section?

A

Repeat cesarean section

169
Q

What is the most common indication for a primary cesarean section?

A

Labor dystocia

170
Q

What are the most common reasons for cesarean sections?

A
  1. Repeat (9% of all births)
  2. Dystocia (7% of all births)
  3. Breech (3% of all births)
  4. Fetal well being (2% of all births)
  5. Other (3% of all births)
171
Q

What is cerebral palsy associated with?

A

Low APGAR scores (0-3 at 10 mins), Low birth weight (500-1500g), hypoxia (pH < 7.0), chorioamnionitis, periventricular leukomalacia

172
Q

What infection in pregnancy is most lethal to the fetus?

A

Parvovirus (1 in 10 infections result in miscarriage or IUFD)

173
Q

What is the most common congenital infection in pregnancy?

A

CMV

174
Q

What is the mortality rate of varicella pneumonia in pregnancy?

A

30%

175
Q

What are the potential fetal effects of parvovirus infection?

A

Stillbirth, hydrops, abortion

176
Q

What are the potential fetal effects with CMV infection?

A

Congenital hearing loss from maternal reactivation, blueberry muffin baby

177
Q

What are the possible fetal effects of varicella infection?

A

Limb hypoplasia, neonatal death, chorioretinitis, cataracts, cutaneous scarring

178
Q

What are the potential fetal effects of toxoplasmosis infection?

A

Hearing and vision deficits

179
Q

What is the treatment for varicella infection during pregnancy?

A

Immune globulin, acyclovir, valcyclovir

180
Q

What is the treatment for toxoplasmosis infection during pregnancy?

A

Spiramycin

181
Q

What testing should be done for suspected parovovirus infection during pregnancy?

A

IgG, IgM, and PCR. Only complete absence of all 3 will ensure non-exposure.

182
Q

What maternal testing can be done with suspected CMV infection during pregnancy?

A

Avidity = 0.6 or less represents an acute infection. This is testing avidity of IgG.

183
Q

What are the fetal ultrasound findings associated with CMV infection?

A

Microcephaly, ventriculomegaly, intracerebral calcifications, ascites, hydrops, echogenic bowel, IUGR, oligohydramnios

184
Q

What is the most common source of toxoplasmosis infection?

A

Undercooked meats that were infected

185
Q

From the Women’s Health Initiative study what are the effects of estrogen only on breast cancer, clots/stroke, heart attack, colon cancer, and fracture risk?

A 
Breast ca - no change
Clots/stroke - increased risk
Heart attack - no change
Colon ca - no change
Fracture risk - decreased
186
Q

From the Women’s Health Initiative study what are the effects of estrogen and progesterone combined on breast cancer, clots/stroke, heart attack, colon cancer, and fracture risk?

A 
Breast ca - increased
clots/stroke - increased
heart attack - increased
colon ca - decreased
fracture risk - decreased
187
Q

What is the most common blood type?

A

O positive

188
Q

What is the least common blood type?

A

AB negative

189
Q

What is the diagnostic criteria for metabolic syndrome?

A

Need 3 out of 5:

  • blood pressure 130/85
  • waist circumference 88cm/35in
  • HDL < 50
  • Blood sugar > 100
  • Triglycerides > 150
190
Q

What are the New York Heart Association classifications?

A

Class 1 - no limitation
Class 2 - slight limitations (symptoms with activity)
Class 3 - Marked limitations (symptoms with minimal activity)
Class 4 - Bedrest (symptoms at rest)

191
Q

What does SIGECAPS stand for?

A

Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor agitation, Suicide

192
Q

What is the interpretation of someone with the following lab testing?
HBs Ag pos; Anti-HBc pos; IgM Anti-HBc pos; Anti-HBs neg

A

Acutely infected with hep B

193
Q

What is the interpretation of someone with the following lab testing?
HBs Ag pos; Anti-HBc pos; IgM Anti-HBc neg; Anti-HBs neg

A

Chronically infected with hep B

194
Q

What factors are included in the FRAX score?

A

Age, Sex, BMI, prev fractures, FHx of fractures, rheumatoid arthritis, smoking status, alcohol intake, steroid use

195
Q

When should you treat someone based off the FRAX score?

A

> 3% risk of hip fracture OR

>20% risk of major fracture

196
Q

Where does the lymphatic drainage of the upper, middle, and lower 1/3s of the vagina go to?

A

Upper 1/3 = Iliac
Middle 1/3 = Hypogastrics
Lower 1/3 = inguinal

197
Q

What is the arterial blood supply of the upper, middle, and lower 1/3s of the vagina?

A

Upper - cervical branch of uterine
Middle - Inferior vesical
Lower - internal pudendal and middle hemorrhoidal

198
Q

What nerves supply the uterus?

A

Hypogastric plexus, sympathetics, Frankenhauser’s plexus

199
Q

What muscles compose the levator ani?

A

Iliococcygeus, pubococcygeus, puborectalis(comprises part of the internal anal sphincter)

200
Q

What defines primary syphilis (signs/symptoms, time line)?

A

Hard, painless chancre that develops in 3 weeks and heals within 2-6 weeks

201
Q

What defines secondary syphilis (signs/symptoms, timing)?

A

Systemic disease that develops from 6 weeks to 6 months after primary chancre. Rash on palms and soles. Vulvar condyloma latum - associated with painless lymphadenopathy

202
Q

What defines latent syphilis (signs/symptoms, timing)?

A

2 - 20 years. Most females are diagnosed by positive blood tests in the latent stage.

203
Q

What defines tertiary syphilis (signs/symptoms, timing)?

A

Develops in 33% of untreated patients. Potentially destructive effects on CNS, CV, and MSK systems. Manifestations - optic atrophy, tabes dorsalis, generalized paresis, aortic aneurysm and gummas of the skin and bones

204
Q

What is the treatment for syphilis at the different stages?

A

Primary, secondary, and 1st year of latent syphilis: Benzathine PCN G 2.4 million units IM (if allergic, use tetracycline. in pregnancy desensitize to PCN).
Late latent or tertiary syphilis: Benzathine PCN G 7.2 million units IM.
Neurosyphilis: Aqueous Crystalline PCN G

205
Q

Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, FSH level, y/n required gonadectomy for TURNERS

A

45X, female, no breast, yes uterus, high FSH, no gonadectomy

206
Q

Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, FSH level, y/n required gonadectomy, cause of SWYERS

A

46XY, female, no breast, yes uterus, increased FSH, yes gonadectomy, caused by deficiency of SRY gene

207
Q

Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, FSH level, y/n required gonadectomy for 17 Hydroxylase deficiency

A

46XX, female, no breast, yes uterus, increased FSH, no gonadectomy.
46XY, female, no breast, no uterus, increased FSH, yes gonadectomy.
Additional finding - HTN in both

208
Q

Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, FSH level, y/n required gonadectomy for 17-20 desmolase deficiency

A

46XY, female, no breast, no uterus, increased FSH, no gonadectomy (no gonads)

209
Q

Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, testosterone level, y/n required gonadectomy, cause of ANDROGEN INSENSITIVITY SYNDROME

A

46XY, female, yes breast, no uterus, male testosterone level, yes gonadectomy (after puberty), caused by androgen receptor defect

210
Q

Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, testosterone level, y/n required gonadectomy for MULLERIAN AGENESIS

A

46XX, yes breast, no uterus, female testosterone levels, no gonadectomy

211
Q

Will leptin be high, low, or normal in a person with anorexia nervosa?

A

Low

212
Q

What does Ghrelin do?

A

Stimulate Growth hormone

213
Q

Name karyotype, mode of transmission, signs/symptoms, and reproductive challenges for KALLMAN SYNDROME

A

46 XX, 3 modes of transmission [X-linked (most common), autosomal dom, autosomal rec], primary amenorrhea, anosmia, hypogonadotropic hypogonadism. Can produce oocytes, ovulate, carry, and deliver, but often need induction of ovulation

214
Q

Name karyotype, inheritance, signs/symptoms, and reproductive challenges for KLINEFELTER SYNDROME

A

47 XXY, non-disjunctional event involving sex chromosomes with error in spermato or oogenesis, Tall stature, 1/3 have gynecomastia. Primary infertility.

215
Q

Name signs/symptoms of MCCUNE ALBRIGHT

A

Triad: cafe-au-lait spots, fibrous dysplasia, bone cysts (skull, long bones).
Isosexual precocious puberty (40%), GnRH independent, diagnosed and treated as neonate > normal puberty, if untreated then precocious puberty

216
Q

Name karyotype, signs/symptoms, and reproductive challenges for JACOB SYNDROME

A

47XYY, aggressive behavior found in some studies, phenotypically normal. Fertile. However, female partners are known to have increased or repetitive miscarriage

217
Q

What is the most common cause of primary amenorrhea?

A

Gonadal failure

218
Q

What is the second most common cause of primary amenorrhea?

A

Congenital absence of the uterus

219
Q

What should the work up for primary amenorrhea be with a girl who both has breasts and a uterus?

A

beta hcg, TSH, prolactin level, progesterone challenge

220
Q

What is the most common (Ovary):

Malignancy, Primary malignancy, neoplasm, mass of ovary

A

Metastatic, Serous cystadenocarcinoma, mature teratoma, functional cyst

221
Q

What are the tumor markers for dysgerminoma?

A

beta hcg, LDH

222
Q

What are the tumor markers for endodermal sinus tumor (yolk sac)?

A

AFP

223
Q

What are the tumor markers for choriocarcinoma?

A

beta hcg

224
Q

What are the tumor markers for immature teratoma?

A

AFP, LDH, ca 125

225
Q

What are the tumor markers for embryonal carcinoma?

A

beta hcg, AFP

226
Q

What % of ovarian tumors are epithelial?

A

80-85%

227
Q

What are the types of epithelial ovarian cancers?

A

Serous, mucinous, endometrioid, clear cell, brenner

228
Q

What are the types of germ cell tumors?

A

Immature teratoma, mature teratoma, dysgerminoma, gonadoblastoma, endodermal sinus (yolk sac tumor), embryonal carcinoma, non-gestational choriocarcinoma

229
Q

What are the types of stromal ovarian cancers?

A

Granulosa cell, fibroma, thecoma, sertoli-leydig, lipid cell, gynandroblastoma

230
Q

What is a histologic finding in serous ovarian cancer?

A

Psammoma bodies

231
Q

What is a histologic finding in Brenner tumors of the ovary?

A

Walthard Cell rests (aka nests)

232
Q

What histological finding is present in endodermal sinus (yolk sac) tumors?

A

Schiller Duval bodies

233
Q

What histological finding is present in granulosa cell tumors?

A

Call-Exner bodies

234
Q

What is the most common type of degeneration with myomas?

A

Hyaline (65%)

235
Q

What is the most common type of myoma degeneration in pregnancy?

A

Carneous (red)

236
Q

What is the most common gyn malignancy (in the US)?

A

Endometrial cancer

237
Q

What is the most lethal gyn malignancy?

A

Ovarian cancer

238
Q

Where are hob nail cells seen?

A

Clear cell carcinoma

239
Q

Where are schiller duval bodies seen?

A

Endodermal sinus tumors

240
Q

Where are Call-Exner bodies seen?

A

Granulosa cell

241
Q

Where are Reinke crystalloids seen?

A

Lipid (hilus) cell tumors

242
Q

Where are Psammoma bodies seen?

A

Serous cystadenoma and pap serous

243
Q

Where are signet ring cells seen?

A

Krukenberg tumors (can also been seen in some cervical ca)

244
Q

What is the major toxicity of bleomycin?

A

Pulmonary fibrosis

245
Q

What is a major toxicity of doxorubicin?

A

Cardiotoxic

246
Q

Side effects of vincristine?

A

High neuro toxicity, low marrow toxicity

247
Q

Side effects of vinblastine

A

High marrow toxicity, low neuro toxicity

248
Q

Major toxicity of cisplatin?

A

Renal toxicity

249
Q

Major toxicity of 5-FU?

A

Cerebellar ataxia, myelosupression

250
Q

Major toxicity of cyclophosphamide?

A

Hemorrhagic cystitis, SIADH

251
Q

Toxicity of doxorubicin?

A

cardiotoxic

252
Q

What is the mechanism of action of cyclophosphamide? What phase of cell cycle is it most active?

A

Intercalates DNA. Mostly cell non-specific, however interacts with DNA and most likely in the S phase

253
Q

What type of an agent in cyclophosphamide?

A

Alkylating agent

254
Q

What is the mechanism of action of methotrexate? What phase of cell cycle is it most active?

A

Dihydrofolate reductase inhibitor leading to thymidine depletion and thus inhibition of purine synthesis. Acts on S phase.

255
Q

What is the mechanism of action of Gemcitabine? What phase of cell cycle is it most active?

A

Inhibits DNA synthesis. S Phase.

256
Q

What type of agent is methotrexate?

A

Antimetabolite

257
Q

What type of agent is gemcitabine?

A

Antimetabolite

258
Q

What is the mechanism of action of cisplatin? What phase of cell cycle is it most active?

A

DNA helix distortion and base pair bonding. Mostly cell non-specific.

259
Q

What is the mechanism of action of carboplatin? What phase of cell cycle is it most active?

A

DNA helix distortion and base pair bonding. Mostly cell non-specific.

260
Q

What is the mechanism of action of doxorubicin? What phase of cell cycle is it most active?

A

Inhibits topoisomerase II, DNA breaks, free radical formation. G1 phase, cell growth.

261
Q

What is the mechanism of action of bleomycin? What phase of cell cycle is it most active?

A

Uses copper and iron to create superoxide free radicals. G2 phase, cell growth.

262
Q

What is the mechanism of action of vincristine/vinblastine? What phase of cell cycle is it most active?

A

Binds to tubulin subunits and leads to mitotic arrest by inhibition of the mitotic spindle. M phase.

263
Q

What is the mechanism of action of etoposide? What phase of cell cycle is it most active?

A

Inhibition of topoisomerase 2 activity. G2 phase.

264
Q

What is the mechanism of action of topotecan? What phase of cell cycle is it most active?

A

Binds to topoisomerase 1 leading to DS DNA breaks. G2 phase.

265
Q

What is the mechanism of action of paclitaxel? What phase of cell cycle is it most active?

A

Stabilized microtubules. M phase.

266
Q

What is the mechanism of action of megesterol acetate? What phase of cell cycle is it most active?

A

Believed to down regulate estrogen receptors in tumor. G1 phase.

267
Q

What is the mechanism of action of tamoxifen? What phase of cell cycle is it most active?

A

Reversibly binds estrogen receptors limiting estrogen mediated protein synthesis. G1 phase.

268
Q

What is the mechanism of action of bevacizumab? What phase of cell cycle is it most active?

A

Inhibits VEGF-A, inhibiting angiogenesis. Tumor targeted therapy.

269
Q

What is the mechanism of action of Olaparib? What phase of cell cycle is it most active?

A

Poly ADP-Ribose Polymerase (PARP) inhibitor and impairing DNA repair. Tumor targeted therapy.

270
Q

What are the nerve roots of the femoral nerve?

A

L2-L4

271
Q

What are the nerve roots of the obturator nerve?

A

L2-L4

272
Q

What are the nerve roots of the common peroneal nerve?

A

L4, L5, S1, S2

273
Q

What are the nerve roots of the genitofemoral nerve?

A

L1, L2

274
Q

Teratogenic effect of tetracyclines?

A

Hypoplasia and staining of fetal teeth

275
Q

Teratogenic effect of sulfonamides?

A

Kernicterus of the newborn

276
Q

Teratogenic effect of streptomycin?

A

Fetal high tone hearing loss

277
Q

Teratogenic effect of chloramphenicol?

A

Gray baby syndrome

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