5 Star Study Guide Flashcards
1
Q
Which antibodies cause severe HDFN?
A
Anti-RhD; Anti-RhE; Anti-Kell (K1); Anti-Rhc
2
Q
Which antibodies do not cause hemolytic disease?
A
LEWIS, l, Duffy (Fyb)
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)
4
Q
When should you complete the nuchal translucency?
A
Between 11w0d and 13w6d
[CRL between 45 and 84mm]
5
Q
Greater than what value for a nuchal translucency warrants further evaluation?
A
> 3mm
6
Q
A large nuchal translucency is associated with what?
A
Down’s syndrome, Trisomy 18, Congenital heart disease/cardiac malformation (most commonly associated)
7
Q
What crosses the placenta by simple diffusion?
A
Oxygen, CO2, electrolytes, ketones
8
Q
What crosses the placenta by active transport?
A
Amino acids, calcium, phosphorous, iron
9
Q
What crosses the placenta by facilitated diffusion?
A
Glucose, sucrose, fructose
10
Q
What crosses the placenta by endocytosis?
A
IgG
11
Q
What crosses the placenta by bulk flow?
A
Water
12
Q
What crosses the placenta with carrier mediated transport?
A
Iodine
13
Q
True or false: PTU crosses the placenta?
A
True
14
Q
True or false: TRH crosses the placenta?
A
True
15
Q
True or false: Iodine crosses the placenta?
A
True
16
Q
True or false: Magnesium sulfate crosses the placenta?
A
True
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
18
Q
True or false: IgG crosses the placenta?
A
True
19
Q
True or false: Propanalol crosses the placenta?
A
True
20
Q
True or false: T3 crosses the placenta?
A
True
21
Q
True or false: T4 crosses the placenta?
A
True
22
Q
True or false: Heparin crosses the placenta?
A
False
23
Q
True or false: Insulin crosses the placenta?
A
False
24
Q
True or false: TSH crosses the placenta?
A
False
25
Increase, decrease, or no change during pregnancy?
| Heart Rate
Increase
26
Increase, decrease, or no change during pregnancy?
| Cardiac Output
Increase
27
Increase, decrease, or no change during pregnancy?
| Plasma Volume
Increase
28
Increase, decrease, or no change during pregnancy?
| Red Cell volume
Increase
29
Increase, decrease, or no change during pregnancy?
| GFR
Increase
30
Increase, decrease, or no change during pregnancy?
| Systemic Vascular Resistance
Decrease
31
Increase, decrease, or no change during pregnancy?
| CO2
Decrease
32
```
Increase, decrease, or no change during pregnancy?
Respiratory Volume (aka lung volume)
```
Decrease
33
Increase, decrease, or no change during pregnancy?
| Total thyroxine
Increase (total T4)
34
Increase, decrease, or no change during pregnancy?
| Total triiodothyronine
Increase (Total T3)
35
Increase, decrease, or no change during pregnancy?
| Thyroxine binding globulin
increase
36
Increase, decrease, or no change during pregnancy?
| PTH
Increase
37
Increase, decrease, or no change during pregnancy?
| Prolactin
Increase
38
Increase, decrease, or no change during pregnancy?
| Prostacyclin (aka Prostaglandin I2)
Increase.
| Inhibits platelet aggregation and causes vasodilation
39
Increase, decrease, or no change during pregnancy?
| Thromboxane
Increases
| Causes blood clotting and vasoconstriction
40
Increase, decrease, or no change during pregnancy?
| Cholesterol
Increases
41
Increase, decrease, or no change during pregnancy?
| ESR
Increases
42
Increase, decrease, or no change during pregnancy?
| Plasma fibrinogen
Increases
43
Increase, decrease, or no change during pregnancy?
| Hemoglobin/hematocrit
Decreases
44
Increase, decrease, or no change during pregnancy?
| Creatinine
Decreases
45
Increase, decrease, or no change during pregnancy?
| BUN
Decreases
46
Increase, decrease, or no change during pregnancy?
| Total serum calcium
Decreases
47
Effect of progesterone (increase or decrease) on appetite?
Increase
48
Effect of progesterone (increase or decrease) on minute ventilation?
Increase
49
Effect of progesterone (increase or decrease) on body temperature?
Increase
50
Effect of progesterone (increase or decrease) on nasal congestion?
Increase
51
Effect of progesterone (increase or decrease) on LDL?
Increase
52
Effect of progesterone (increase or decrease) on depression?
Increase
53
Effect of progesterone (increase or decrease) on tubal mobility?
decrease
54
Effect of progesterone (increase or decrease) on lining on the uterus
decrease (thin)
55
Effect of progesterone (increase or decrease) on ureteral mobility?
Decrease
56
Effect of progesterone (increase or decrease) on esophageal sphincter tone?
Decrease
57
Effect of progesterone (increase or decrease) on HDL?
Decrease
58
Increase, decrease, or no change during pregnancy?
| Residual volume
Decrease
| Amount of air that remains in a person's lung after fully exhaling
59
Increase, decrease, or no change during pregnancy?
| Expiratory reserve volume
Decrease
| The amount of extra air exhaled during a forceful breath out
60
Increase, decrease, or no change during pregnancy?
| Total lung capacity
Decrease
| Maximum amount of air your lungs can hold
61
Increase, decrease, or no change during pregnancy?
| Functional residual capacity
Decreases
| Volume remaining in lungs after normal, passive, exhale
62
Increase, decrease, or no change during pregnancy?
| Inspiratory capacity
Increases
| Maximum volume of air that can be inspired after a normal, quiet expiration
63
Increase, decrease, or no change during pregnancy?
| Tidal volume
Increases
| Amount of air that moves in and out with each breath
64
Increase, decrease, or no change during pregnancy?
| Vital capacity
No change
| Greatest amount of air that can be expelled from the lungs after taking the deepest possible breath
65
Increase, decrease, or no change during pregnancy?
| Inspiratory reserve volume
No change
| The volume of air a person can inhale after a normal inhalation
66
Increase, decrease, or no change during pregnancy?
| Factor 1
Increase
Factor 1 is fibrinogen
Procoagulant
67
Increase, decrease, or no change during pregnancy?
| Factor 7
Increase
| Procoagulant
68
Increase, decrease, or no change during pregnancy?
| Factor 8
Increase
| Procoagulant
69
Increase, decrease, or no change during pregnancy?
| Factor 10
Increase
| Procoagulant
70
Increase, decrease, or no change during pregnancy?
| Von Willebrand Factor
Increase
| Procoagulant
71
Increase, decrease, or no change during pregnancy?
| Plasminogen activator inhibitor 1 (PAI-1)
Increases.
One of the most important inhibitors of the plasma fibrinolytic activity; rapid acting
Procoagulant
72
Increase, decrease, or no change during pregnancy?
| Plasminogen Activator Inhibitor 2 (PAI-2)
Increases
| Procoagulant
73
Increase, decrease, or no change during pregnancy?
| Factor 11
Decrease
| Procoagulant
74
Increase, decrease, or no change during pregnancy?
| Factor 13
Decrease
| Procoagulant
75
Increase, decrease, or no change during pregnancy?
| Factor 2
No change
| Procoagulant
76
Increase, decrease, or no change during pregnancy?
| Factor 5
No change
| Procoagulant
77
Increase, decrease, or no change during pregnancy?
| Factor 9
No change
| Procoagulant
78
Increase, decrease, or no change during pregnancy?
| Protein S
Decreases (actual number increases by trimester, overall still decreased)
Anticoagulant
79
Increase, decrease, or no change during pregnancy?
| Protein C
No Change
| Anticoagulant
80
Increase, decrease, or no change during pregnancy?
| Anti thrombin 3
No change
| Anticoagulant
81
Increase, decrease, or no change during pregnancy?
| T4
Increase
82
Increase, decrease, or no change during pregnancy?
| Iodide
Decrease
83
Increase, decrease, or no change during pregnancy?
| Free T4
No change
84
Increase, decrease, or no change during pregnancy?
| TSH
No change (does decrease slightly in the first 10 weeks d/t bHCG)
85
What hyperthyroid medication should you use in the first trimester?
PTU
86
What hyperthyroid medication should you use in the 2nd and 3rd trimesters?
Methimazole
87
What teratogenic effect is seen with methimazole?
Aplasia cutis (congenital lack of skin, most commonly on scalp)
88
Which antithyroid drug is known to cause agranulocytosis?
Both PTU and methimazole
89
Why do we restrict use of PTU in pregnancy?
Risk of hepatotoxicity. Only use in the first trimester
90
What is the limiting pelvic dimension for vaginal delivery?
Ischial spines (mid pelvis)
91
What is the average bispinous diameter in women?
10.5cm
92
What is the diagonal conjugate?
The symphysis pubis to the sacral promontory
93
Which conjugate (true, obstetric, diagonal) is the shortest?
Obstetric
94
Which conjugate (true, obstetric, diagonal) can be clinically assessed?
Diagonal
95
How do you estimate the obstetric conjugate?
Diagonal conjugate - 1.5cm
96
What is the definition of a contracted obstetrical conjugate?
< 10.5cm
97
What is the average biparietal diameter at term?
9.3cm
98
What is the average femur length at term?
7.4cm
99
What is the definition of engagement?
The BPD passed the plane of the inlet. Presenting part is at the ischial spines
100
What is the best pelvic shape for vaginal birth?
Gynecoid
101
What pelvic shape is associated with increased OP delivery?
Anthropoid
102
What pelvic shape is associated with persistent transverse presentation?
Platypelloid
103
What pelvic shape is the worst for vaginal delivery?
Android
104
What fraction of twins are dizygous?
2/3
105
What fraction of monozygous twins are mono-di?
2/3
106
What fraction of twins (excluding mono-mono) can be delivered vaginally?
2/3 (40% vertex/vertex, 25% vertex/breech)
107
How do you calculate growth discordance?
(EFW large - EFW small)/EFW large
108
During what days after fertilization would a split lead to di-di twins?
0-3 days
109
During what days after fertilization would a split lead to mono-di twins?
4-8 days
110
During what days after fertilization would a split lead to mono-mono twins?
9-12 days
111
How many days after fertilization would a split lead to conjoined days?
13 + days
112
What is the most common type of conjoined twins?
Thoracophagus
113
What % of twins are dizygous vs monozygous?
66% dizygous, 33% monozygous
114
What is the breakdown of di-di, mono-di, mono-mono, and conjoined from a monozygous twin pregnancy?
1/3 di-di; 2/3, mono-di; <1% mono-mono; <1% conjoined
115
In terms of maternal mortality, what cardiac issues are low risk (Mortality < 1%)?
ASD, VSD, PDA, pulmonic/tricuspid diseases, corrected tetralogy of Fallot, porcine valve, mitral stenosis (NYHA classes 1 and 2)
116
In terms of maternal mortality, what cardiac issues have moderate risk (mortality 5-15%)?
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
In terms of maternal mortality, what cardiac issues are high risk (mortality 25-50%)?
Pulmonary HTN, Coarctation of the aorta (complicated), Eisenmenger syndrome, Marfan syndrome with aortic involvement (>4cm)
118
In the US what are the top causes of maternal death (with %)?
```
CV 14.6%
Infection 13.6%
Cardiomyopathy 12%
Hemorrhage 10%
Preeclampsia 9.4%
Thromboembolism 9.3%
```
119
How many mg of iron are required for an entire pregnancy?
1,000mg (an increase of 800mg from non pregnant persons)
120
How much elemental iron is in, and how much is absorbed from, 325mg ferrous sulfate (oral preparation)?
65mg elemental iron. 6.5mg gets absorbed.
121
What are the diagnostic criteria for peripartum cardiomyopathy?
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
What is the most common cited cause of peripartum cardiomyopathy?
Myocarditis
123
What is the mortality rate within 2 years of diagnosis of peripartum cardiomyopathy?
10%
124
What is the treatment for peripartum cardiomyopathy?
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
What % of women diagnosed with peripartum cardiomyopathy with regain ventricular function within 6 months?
~50%. Portends good prognosis
126
What are poor prognostic factors for peripartum cardiomyopathy?
Black race, age > 35-40yrs, LVEF < 25%
127
What is the inheritance pattern of Marfan's?
Autosomal Dominant
128
What is the inheritance pattern of Neurofibromatosis?
Autosomal dominant
129
What is the inheritance pattern of Huntingtons Chorea?
autosomal dominant
130
What is the inheritance pattern of Von Willebrand's disease?
Autosomal dominant
131
What is the inheritance pattern of polycystic kidney disease with adult onset?
autosomal dominant
132
What is the inheritance pattern of PKU?
autosomal recessive
133
What is the inheritance pattern of congenital adrenal hyperplasia?
autosomal recessive
134
What is the inheritance pattern of thalassemias?
autosomal recessive
135
What is the inheritance pattern of cystic fibrosis?
autosomal recessive
136
What is the inheritance pattern of galactosemia?
autosomal recessive
137
What is the inheritance pattern of Tay Sachs?
autosomal recessive
138
What is the inheritance pattern of mucopolysaccharidosis?
autosomal recessive
139
What is the inheritance pattern of diabetes insipidus?
can be x-linked, can be autosomal dominant, can be autosomal recessive.
140
What is the inheritance pattern of hemophilia?
X linked recessive
141
What is the inheritance pattern of muscular dystophy?
X-linked recessive
142
What is the inheritance pattern of testicular feminization (aka androgen insensitivity syndrome)?
X linked
143
What is the inheritance pattern of neural tube defects?
Multifactorial
144
What is the inheritance pattern of mullerian agenesis?
multifactorial
145
What is the recurrence rate (with same parents) after one child is born with an autosomal dominant condition?
50%
146
What is the recurrence rate (with same parents) after one child is born with an autosomal recessive condition?
25%
147
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)?
~3-5%
148
What is the recurrence rate (with same parents) after one child is born a chromosomal error (eg trisomy 21, turners)?
1%
149
What features are associated with Edwards syndrome (trisomy 18)?
Small for gestational age, 2 vessel cord, short sternum, overlapping clenched fingers, rocker bottom feet
150
What findings are associated with Patau syndrome (trisomy 13)?
Small for gestational age, facial clefts, ocular anomalies, and polydactly
151
What findings are associated with cri-du-chat (chromosome 5 p deletion)?
High pitched cry, epicanthal fold, mental retardation
152
What are the findings associated with Turner's syndrome?
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
What is associated with high MSAFP?
```
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
What is associated with low MSAFP?
```
Chromosomal trisomies (13, 18, 21)
Gestational trophoblastic disease
Fetal death (Can also be associated with high MSAFP)
Overestimated gestational age
Increased maternal weight
```
155
What conditions are associated with cystic hygroma?
Fetal hydrops, Turner's syndrome, Noonan syndrome
156
How do you calculated weight-based insulin in pregnancy?
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
What are the cardinal movements of labor?
Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
158
What are the number of oocytes by age (20wk gestation, term birth, puberty, after 50)?
20w gestation: 6-7 million
Term birth: 1-2 million
Puberty: 500,000
After 50: 1,000
159
What is the maximum Bishop score?
13
160
What does APGAR stand for?
Activity (tone), Pulse (HR), Grimace (reflex irritability), appearance (color), Respirations
161
What nerve roots are injured in Erb's palsy?
C5-6
162
What muscles are effected in Erb's palsy?
Deltoid, infraspinatus, forearm flexor
163
Is Erb's palsy or Klumpke's palsy more common?
Erb's palsy
164
What nerve roots are effected in Klumpke's palsy?
C8-T1
165
What % of infants with a brachial plexus injury are left with significant residual deficits?
15%
166
What are the most common sequelae of vacuum assisted vaginal deliveries (to the newborn)?
Hyperbilirubinemia (most common d/t increased risk of cephalohematoma), scalp laceration (33%), cephalohematoma (16%), subgaleal hematoma (3%, most lethal)
167
What is the C section rate in the US?
31.8%
168
What is the most common indication for a cesarean section?
Repeat cesarean section
169
What is the most common indication for a primary cesarean section?
Labor dystocia
170
What are the most common reasons for cesarean sections?
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
What is cerebral palsy associated with?
Low APGAR scores (0-3 at 10 mins), Low birth weight (500-1500g), hypoxia (pH < 7.0), chorioamnionitis, periventricular leukomalacia
172
What infection in pregnancy is most lethal to the fetus?
Parvovirus (1 in 10 infections result in miscarriage or IUFD)
173
What is the most common congenital infection in pregnancy?
CMV
174
What is the mortality rate of varicella pneumonia in pregnancy?
30%
175
What are the potential fetal effects of parvovirus infection?
Stillbirth, hydrops, abortion
176
What are the potential fetal effects with CMV infection?
Congenital hearing loss from maternal reactivation, blueberry muffin baby
177
What are the possible fetal effects of varicella infection?
Limb hypoplasia, neonatal death, chorioretinitis, cataracts, cutaneous scarring
178
What are the potential fetal effects of toxoplasmosis infection?
Hearing and vision deficits
179
What is the treatment for varicella infection during pregnancy?
Immune globulin, acyclovir, valcyclovir
180
What is the treatment for toxoplasmosis infection during pregnancy?
Spiramycin
181
What testing should be done for suspected parovovirus infection during pregnancy?
IgG, IgM, and PCR. Only complete absence of all 3 will ensure non-exposure.
182
What maternal testing can be done with suspected CMV infection during pregnancy?
Avidity = 0.6 or less represents an acute infection. This is testing avidity of IgG.
183
What are the fetal ultrasound findings associated with CMV infection?
Microcephaly, ventriculomegaly, intracerebral calcifications, ascites, hydrops, echogenic bowel, IUGR, oligohydramnios
184
What is the most common source of toxoplasmosis infection?
Undercooked meats that were infected
185
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?
```
Breast ca - no change
Clots/stroke - increased risk
Heart attack - no change
Colon ca - no change
Fracture risk - decreased
```
186
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?
```
Breast ca - increased
clots/stroke - increased
heart attack - increased
colon ca - decreased
fracture risk - decreased
```
187
What is the most common blood type?
O positive
188
What is the least common blood type?
AB negative
189
What is the diagnostic criteria for metabolic syndrome?
Need 3 out of 5:
- blood pressure 130/85
- waist circumference 88cm/35in
- HDL < 50
- Blood sugar > 100
- Triglycerides > 150
190
What are the New York Heart Association classifications?
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
What does SIGECAPS stand for?
Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor agitation, Suicide
192
What is the interpretation of someone with the following lab testing?
HBs Ag pos; Anti-HBc pos; IgM Anti-HBc pos; Anti-HBs neg
Acutely infected with hep B
193
What is the interpretation of someone with the following lab testing?
HBs Ag pos; Anti-HBc pos; IgM Anti-HBc neg; Anti-HBs neg
Chronically infected with hep B
194
What factors are included in the FRAX score?
Age, Sex, BMI, prev fractures, FHx of fractures, rheumatoid arthritis, smoking status, alcohol intake, steroid use
195
When should you treat someone based off the FRAX score?
> 3% risk of hip fracture OR
| >20% risk of major fracture
196
Where does the lymphatic drainage of the upper, middle, and lower 1/3s of the vagina go to?
Upper 1/3 = Iliac
Middle 1/3 = Hypogastrics
Lower 1/3 = inguinal
197
What is the arterial blood supply of the upper, middle, and lower 1/3s of the vagina?
Upper - cervical branch of uterine
Middle - Inferior vesical
Lower - internal pudendal and middle hemorrhoidal
198
What nerves supply the uterus?
Hypogastric plexus, sympathetics, Frankenhauser's plexus
199
What muscles compose the levator ani?
Iliococcygeus, pubococcygeus, puborectalis(comprises part of the internal anal sphincter)
200
What defines primary syphilis (signs/symptoms, time line)?
Hard, painless chancre that develops in 3 weeks and heals within 2-6 weeks
201
What defines secondary syphilis (signs/symptoms, timing)?
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
What defines latent syphilis (signs/symptoms, timing)?
2 - 20 years. Most females are diagnosed by positive blood tests in the latent stage.
203
What defines tertiary syphilis (signs/symptoms, timing)?
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
What is the treatment for syphilis at the different stages?
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
Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, FSH level, y/n required gonadectomy for TURNERS
45X, female, no breast, yes uterus, high FSH, no gonadectomy
206
Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, FSH level, y/n required gonadectomy, cause of SWYERS
46XY, female, no breast, yes uterus, increased FSH, yes gonadectomy, caused by deficiency of SRY gene
207
Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, FSH level, y/n required gonadectomy for 17 Hydroxylase deficiency
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
Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, FSH level, y/n required gonadectomy for 17-20 desmolase deficiency
46XY, female, no breast, no uterus, increased FSH, no gonadectomy (no gonads)
209
Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, testosterone level, y/n required gonadectomy, cause of ANDROGEN INSENSITIVITY SYNDROME
46XY, female, yes breast, no uterus, male testosterone level, yes gonadectomy (after puberty), caused by androgen receptor defect
210
Name Karyotype, phenotype (male/female), y/n breasts, y/n uterus, testosterone level, y/n required gonadectomy for MULLERIAN AGENESIS
46XX, yes breast, no uterus, female testosterone levels, no gonadectomy
211
Will leptin be high, low, or normal in a person with anorexia nervosa?
Low
212
What does Ghrelin do?
Stimulate Growth hormone
213
Name karyotype, mode of transmission, signs/symptoms, and reproductive challenges for KALLMAN SYNDROME
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
Name karyotype, inheritance, signs/symptoms, and reproductive challenges for KLINEFELTER SYNDROME
47 XXY, non-disjunctional event involving sex chromosomes with error in spermato or oogenesis, Tall stature, 1/3 have gynecomastia. Primary infertility.
215
Name signs/symptoms of MCCUNE ALBRIGHT
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
Name karyotype, signs/symptoms, and reproductive challenges for JACOB SYNDROME
47XYY, aggressive behavior found in some studies, phenotypically normal. Fertile. However, female partners are known to have increased or repetitive miscarriage
217
What is the most common cause of primary amenorrhea?
Gonadal failure
218
What is the second most common cause of primary amenorrhea?
Congenital absence of the uterus
219
What should the work up for primary amenorrhea be with a girl who both has breasts and a uterus?
beta hcg, TSH, prolactin level, progesterone challenge
220
What is the most common (Ovary):
| Malignancy, Primary malignancy, neoplasm, mass of ovary
Metastatic, Serous cystadenocarcinoma, mature teratoma, functional cyst
221
What are the tumor markers for dysgerminoma?
beta hcg, LDH
222
What are the tumor markers for endodermal sinus tumor (yolk sac)?
AFP
223
What are the tumor markers for choriocarcinoma?
beta hcg
224
What are the tumor markers for immature teratoma?
AFP, LDH, ca 125
225
What are the tumor markers for embryonal carcinoma?
beta hcg, AFP
226
What % of ovarian tumors are epithelial?
80-85%
227
What are the types of epithelial ovarian cancers?
Serous, mucinous, endometrioid, clear cell, brenner
228
What are the types of germ cell tumors?
Immature teratoma, mature teratoma, dysgerminoma, gonadoblastoma, endodermal sinus (yolk sac tumor), embryonal carcinoma, non-gestational choriocarcinoma
229
What are the types of stromal ovarian cancers?
Granulosa cell, fibroma, thecoma, sertoli-leydig, lipid cell, gynandroblastoma
230
What is a histologic finding in serous ovarian cancer?
Psammoma bodies
231
What is a histologic finding in Brenner tumors of the ovary?
Walthard Cell rests (aka nests)
232
What histological finding is present in endodermal sinus (yolk sac) tumors?
Schiller Duval bodies
233
What histological finding is present in granulosa cell tumors?
Call-Exner bodies
234
What is the most common type of degeneration with myomas?
Hyaline (65%)
235
What is the most common type of myoma degeneration in pregnancy?
Carneous (red)
236
What is the most common gyn malignancy (in the US)?
Endometrial cancer
237
What is the most lethal gyn malignancy?
Ovarian cancer
238
Where are hob nail cells seen?
Clear cell carcinoma
239
Where are schiller duval bodies seen?
Endodermal sinus tumors
240
Where are Call-Exner bodies seen?
Granulosa cell
241
Where are Reinke crystalloids seen?
Lipid (hilus) cell tumors
242
Where are Psammoma bodies seen?
Serous cystadenoma and pap serous
243
Where are signet ring cells seen?
Krukenberg tumors (can also been seen in some cervical ca)
244
What is the major toxicity of bleomycin?
Pulmonary fibrosis
245
What is a major toxicity of doxorubicin?
Cardiotoxic
246
Side effects of vincristine?
High neuro toxicity, low marrow toxicity
247
Side effects of vinblastine
High marrow toxicity, low neuro toxicity
248
Major toxicity of cisplatin?
Renal toxicity
249
Major toxicity of 5-FU?
Cerebellar ataxia, myelosupression
250
Major toxicity of cyclophosphamide?
Hemorrhagic cystitis, SIADH
251
Toxicity of doxorubicin?
cardiotoxic
252
What is the mechanism of action of cyclophosphamide? What phase of cell cycle is it most active?
Intercalates DNA. Mostly cell non-specific, however interacts with DNA and most likely in the S phase
253
What type of an agent in cyclophosphamide?
Alkylating agent
254
What is the mechanism of action of methotrexate? What phase of cell cycle is it most active?
Dihydrofolate reductase inhibitor leading to thymidine depletion and thus inhibition of purine synthesis. Acts on S phase.
255
What is the mechanism of action of Gemcitabine? What phase of cell cycle is it most active?
Inhibits DNA synthesis. S Phase.
256
What type of agent is methotrexate?
Antimetabolite
257
What type of agent is gemcitabine?
Antimetabolite
258
What is the mechanism of action of cisplatin? What phase of cell cycle is it most active?
DNA helix distortion and base pair bonding. Mostly cell non-specific.
259
What is the mechanism of action of carboplatin? What phase of cell cycle is it most active?
DNA helix distortion and base pair bonding. Mostly cell non-specific.
260
What is the mechanism of action of doxorubicin? What phase of cell cycle is it most active?
Inhibits topoisomerase II, DNA breaks, free radical formation. G1 phase, cell growth.
261
What is the mechanism of action of bleomycin? What phase of cell cycle is it most active?
Uses copper and iron to create superoxide free radicals. G2 phase, cell growth.
262
What is the mechanism of action of vincristine/vinblastine? What phase of cell cycle is it most active?
Binds to tubulin subunits and leads to mitotic arrest by inhibition of the mitotic spindle. M phase.
263
What is the mechanism of action of etoposide? What phase of cell cycle is it most active?
Inhibition of topoisomerase 2 activity. G2 phase.
264
What is the mechanism of action of topotecan? What phase of cell cycle is it most active?
Binds to topoisomerase 1 leading to DS DNA breaks. G2 phase.
265
What is the mechanism of action of paclitaxel? What phase of cell cycle is it most active?
Stabilized microtubules. M phase.
266
What is the mechanism of action of megesterol acetate? What phase of cell cycle is it most active?
Believed to down regulate estrogen receptors in tumor. G1 phase.
267
What is the mechanism of action of tamoxifen? What phase of cell cycle is it most active?
Reversibly binds estrogen receptors limiting estrogen mediated protein synthesis. G1 phase.
268
What is the mechanism of action of bevacizumab? What phase of cell cycle is it most active?
Inhibits VEGF-A, inhibiting angiogenesis. Tumor targeted therapy.
269
What is the mechanism of action of Olaparib? What phase of cell cycle is it most active?
Poly ADP-Ribose Polymerase (PARP) inhibitor and impairing DNA repair. Tumor targeted therapy.
270
What are the nerve roots of the femoral nerve?
L2-L4
271
What are the nerve roots of the obturator nerve?
L2-L4
272
What are the nerve roots of the common peroneal nerve?
L4, L5, S1, S2
273
What are the nerve roots of the genitofemoral nerve?
L1, L2
274
Teratogenic effect of tetracyclines?
Hypoplasia and staining of fetal teeth
275
Teratogenic effect of sulfonamides?
Kernicterus of the newborn
276
Teratogenic effect of streptomycin?
Fetal high tone hearing loss
277
Teratogenic effect of chloramphenicol?
Gray baby syndrome
