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Endo/repro Flashcards

1
Q

hcg shares an identical alpha subunit as which other hormones:

A

LH, FSH, TSH

As such, high hCG can cause hyperthyroidim

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2
Q

hCG is high in which pregnancy states?

A

Multiple gestations
Hydatidiform moles
Choriocarcinomas
Down syndrome

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3
Q

hCG is low in which pregnancy states?

A

Ectopic/failing pregnancy
Edward syndrome
Patau syndrome

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4
Q

Which common antibiotic can cause a disulfuram-like (i.e. blocks acetaldehyde DH) reaction after ingestion of alcohol?

A

Metronidazole

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5
Q

What are the mechanisms of action of Mifepristone and Misoprostol in inducing abortions?

A 
Misoprostol = Prostaglandin E1 agonist
Mifepristone = Progesterone and glucocorticoid antagonist
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6
Q

Similar to the testicular veins, the right ovarian vein drains into the _____ and the left ovarian vein drains into the ____.

A 
Right = IVC
Left = left renal vein -> IVC
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7
Q

Which female GYN cancer is associated with increased CA-125 levels?

A

Epithelial ovarian

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8
Q

Why do Klinefelter men end up with feminization (e.g. gynecomastia)?

A

Hyalinized seminiferous tubules damage sertoli and leydig cells -> low inhibin and testosterone -> no feedback inhibition on LH/FSH.

Eventually high FSH will cause high estrogen.

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9
Q

Transversalis fascia = _____ inguinal ring

A

Deep

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10
Q

External oblique aponeurosis = ______ inguinal ring

A

Superficial

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11
Q

Which cell type secretes Mullerian Inhibiting Factor?

A

Sertoli

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12
Q

DHT is responsible for forming what structures?

A

External male genitalia:*

Penis
Scrotum
Prostate*

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13
Q

What ligament should be ligated for an oophorectomy?

A

Suspensory ligament

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14
Q

The uterine vessels, which are at risk in a hysterectomy are located within which ligament?

A

Cardinal

(think Cardinal for Cervical)

Note: the ureter runs right under the uterine artery and thus are also at risk.

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15
Q

The ovarian arteries arise from which vessel?

A

Abdominal aorta

USMLE is weirdly into this fact so know it!

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16
Q

Progesterone _________ the myometrial muscles.

A

Relaxes (prevents premature fetus expulsion)

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17
Q

What hormone causes the rise in basal body temperature indicating ovulation?

A

Progesterone

Rob guessed it and Lindsay didn’t!

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18
Q

What does human placental lactogen do?

A

Increases insulin secretion and insulin resistance -> causes increased lipolysis to shunt nutrients to the fetus

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19
Q

Flutamide is a nonsteroid agent that acts as a _________ __________ receptor inhibitor.

A

Competitive testosterone

Used to treat prostate cancer and reduce its size

Cyproterone and spironolactone are similar drugs

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20
Q

What drug class is Tamoxifen? What effect does it have on different tissue types?

A

Selective Estrogen Receptor Modulator (SERM)

Anti-estrogenic effect in breast tissue (used as adjuvant treatment of ER-positive breast cancer)

Stimulatory effect in endometrial tissue possibly leading to endometrial hyperplasia and endometrial cancer.

^^this does NOT happen with Raloxifene though

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21
Q

What is the physical exam finding indicating androgen insensitivity syndrome (46XY) instead of mullerian agenesis (46XX)?

A

Lack of pubic hair = AIS

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22
Q

What renal abnormality is associated with Mullerian Agenesis?

A

Horseshoe kidney

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23
Q

Where do choriocarcinomas often spread and how do they appear on imaging?

A

Most often metastasize to lungs -> “cannonball lesions”

remember, choriocarcinomas DO NOT have chorionic villi

24
Q

What form of estrogen?
The ovary makes ______
Adipose makes _____
The placenta makes _____

What are the relative potencies?

A 
Ovary = estradiol (E2)
Adipose = estrone (E1)
Placenta = estriol (E3)

Estradiol > Estrone > Estriol

25
Q

Which breast cancer is most likely if you see bloody nipple discharge?

A

Intraductal papilloma

Papillary cells with a fibrovascular core

26
Q

What is the mechanism of action of clomiphene?

A

Clomiphene is a selective estrogen receptor modulator that prevents negative feedback inhibition on the hypothalamus and pituitary by circulating estrogen -> increased GnRH (FSH/LH) as a result and increased chance of ovulation

27
Q

How do combined OCPs, progrestin only pills, IUDs, and copper IUDs work to prevent pregnancy?

A

combined OCPs act to suppress GnRH secretion inhibiting ovulation

Progestin-only pills and progesterone secreting IUDs thicken cervical mucus impairing sperm penetration

Copper IUDs create a chronic cytotoxic inflammatory response in the uterus, impairing sperm migration

28
Q

An indirect inguinal hernia forms from a patent _________

What else can form from this?

A

Processus vaginalis (an evagination of the peritoneum)

Note, if the opening is too small for an inguinal hernia to form, fluid an still leak through leading to a communicating hydrocele.

29
Q

Indirect hernias are common in ______ while direct hernias are common in _______.

A 
Indirect = kids
Direct =  older men
30
Q

Indirect hernias develop _______ to the inferior epigastric blood vessels.

A

Indirect = lateral

31
Q

Theca interna cells make _____ from ________ under stimulation from LH.

Then granulosa cells make _________ under stimulation from FSH.

A

Theca interna turns cholesterol into androgens.

Granulosa cells aromatizes androgens into estrogen.

32
Q

The uterine artery (within the cardinal ligament!) is supplied by the anterior division of which artery?

A

Internal iliac

33
Q

Failure of fusion of the urogenital folds in a male causes what?

A

Hypospadias

34
Q

Abnormal positioning of the genital tubercles in a male causes what?

A

Epispadias

35
Q

Which drug puts a mom at risk for a placental abruption?

A

Cocaine

36
Q

Placental abruption is pain___ while placenta previa (placenta covering the cervical os) is pain___.

A

Placental abruption is painful

Placenta previa is painless

37
Q

What is vasa previa?

A

A condition where the fetal blood vessels run right up against the cervical risk. At risk for blood loss and bradycardia requiring emergency C-section.

*note: the bleeding here is PAINLESS

38
Q

What HTN drugs are safe in pregnancy (+mnemonic)?

A

Hypertensive Moms Love Nifedipine

Hydralazine
Methyldopa
Labetalol
Nifedipine

39
Q

What is HELLP syndrome? What do you see on peripheral smear?

A

A severe version of preeclampsia:

Hemolysis
Elevated
Liver enzymes
Low
Platelets

You will see schistocytes on smear

40
Q

What drug is used to deliver the baby in ecamplsia and preeclampsia?

A

Magnesium sulfate

41
Q

_______ is a grape-like mass emerging from a young girl (<4)’s vagina.

A

Sarcoma botryioides

42
Q

How do koilocytes (seen in HPV-induced cervical cancer) appear on histology?

A

Cleared out cytoplasm with a thick basophilic rim and dark nucleus

43
Q

The most common ovarian tumor is what? What cell type?

A

Serous cystadenocarcinoma

Fallopian tube-like epithelium
Present with psammoma bodies

they are often bilateral

44
Q

How do fibroids change with pregnancy and menopause?

A

Increase with pregnancy (i.e. estrogen)

Decrease with menopause

45
Q

___________ = fibrosis, calcifications in the acini and stroma of the breast lobules

A

Sclerosing adenosis

There is a slight increased risk of cancer

46
Q

_________ hyperplasia is found in the lobules of the breast and is associated with increased risk of cancer if there are atypical cells.

A

Epithelial

47
Q

What is fat necrosis in the breast?

A

Painless response to injury
Calcifications
Non-enzymatic
Giant cells

48
Q

Fibroadenomas are completely benign and do NOT require treatment. Just reassurance!

A

Don’t forget

49
Q

What is the primary side effect of Trastuzamab?

A

Cardiotoxicity

50
Q

Which breast cancer causes “stippling of the skin”?

A

NOT referring to inflammatory carcinoma!

This is how they describe invasive ductal carcinoma

51
Q

Varicoceles come from compressed what?

A

Pampiniform plexus

52
Q

Which scrotal fluid accumulation DOES transilluminate?

A

Congenital hydrocele

53
Q

What marker is elevated in seminomas?

A

ALP

placental alkaline phosphatase

54
Q

Prostate cancer mets are osteo______.

A

Osteoblastic

55
Q

Terbutaline and ritrodine are tocolytics used for:

A

Preventing premature birth

They are beta 2 agonists (terbutaline is also beta 1) causing uterine muscle relaxation.

56
Q

Danazol is an older drug that is a synthetic androgen used to treat endometriosis and hereditary angioedema. It has what major side effect?

A

Pseudotumor cerebri that causes an increase in ICP leading to papilledema

^side note, vitamin A can also do this

57
Q

If a patient comes in with suspected MI and you want to give them nitrates, what drug MUST you ask if they have taken first?

A

Sildenafil (Viagra) because it causes vasodilation and the combination can be life threatening.

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