Endo/repro Flashcards
hcg shares an identical alpha subunit as which other hormones:
LH, FSH, TSH
As such, high hCG can cause hyperthyroidim
hCG is high in which pregnancy states?
Multiple gestations
Hydatidiform moles
Choriocarcinomas
Down syndrome
hCG is low in which pregnancy states?
Ectopic/failing pregnancy
Edward syndrome
Patau syndrome
Which common antibiotic can cause a disulfuram-like (i.e. blocks acetaldehyde DH) reaction after ingestion of alcohol?
Metronidazole
What are the mechanisms of action of Mifepristone and Misoprostol in inducing abortions?
Misoprostol = Prostaglandin E1 agonist Mifepristone = Progesterone and glucocorticoid antagonist
Similar to the testicular veins, the right ovarian vein drains into the _____ and the left ovarian vein drains into the ____.
Right = IVC Left = left renal vein -> IVC
Which female GYN cancer is associated with increased CA-125 levels?
Epithelial ovarian
Why do Klinefelter men end up with feminization (e.g. gynecomastia)?
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.
Transversalis fascia = _____ inguinal ring
Deep
External oblique aponeurosis = ______ inguinal ring
Superficial
Which cell type secretes Mullerian Inhibiting Factor?
Sertoli
DHT is responsible for forming what structures?
External male genitalia:*
Penis
Scrotum
Prostate*
What ligament should be ligated for an oophorectomy?
Suspensory ligament
The uterine vessels, which are at risk in a hysterectomy are located within which ligament?
Cardinal
(think Cardinal for Cervical)
Note: the ureter runs right under the uterine artery and thus are also at risk.
The ovarian arteries arise from which vessel?
Abdominal aorta
USMLE is weirdly into this fact so know it!
Progesterone _________ the myometrial muscles.
Relaxes (prevents premature fetus expulsion)
What hormone causes the rise in basal body temperature indicating ovulation?
Progesterone
Rob guessed it and Lindsay didn’t!
What does human placental lactogen do?
Increases insulin secretion and insulin resistance -> causes increased lipolysis to shunt nutrients to the fetus
Flutamide is a nonsteroid agent that acts as a _________ __________ receptor inhibitor.
Competitive testosterone
Used to treat prostate cancer and reduce its size
Cyproterone and spironolactone are similar drugs
What drug class is Tamoxifen? What effect does it have on different tissue types?
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
What is the physical exam finding indicating androgen insensitivity syndrome (46XY) instead of mullerian agenesis (46XX)?
Lack of pubic hair = AIS
What renal abnormality is associated with Mullerian Agenesis?
Horseshoe kidney
Where do choriocarcinomas often spread and how do they appear on imaging?
Most often metastasize to lungs -> “cannonball lesions”
remember, choriocarcinomas DO NOT have chorionic villi
What form of estrogen?
The ovary makes ______
Adipose makes _____
The placenta makes _____
What are the relative potencies?
Ovary = estradiol (E2) Adipose = estrone (E1) Placenta = estriol (E3)
Estradiol > Estrone > Estriol
Which breast cancer is most likely if you see bloody nipple discharge?
Intraductal papilloma
Papillary cells with a fibrovascular core
What is the mechanism of action of clomiphene?
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
How do combined OCPs, progrestin only pills, IUDs, and copper IUDs work to prevent pregnancy?
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
An indirect inguinal hernia forms from a patent _________
What else can form from this?
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.
Indirect hernias are common in ______ while direct hernias are common in _______.
Indirect = kids Direct = older men
Indirect hernias develop _______ to the inferior epigastric blood vessels.
Indirect = lateral
Theca interna cells make _____ from ________ under stimulation from LH.
Then granulosa cells make _________ under stimulation from FSH.
Theca interna turns cholesterol into androgens.
Granulosa cells aromatizes androgens into estrogen.
The uterine artery (within the cardinal ligament!) is supplied by the anterior division of which artery?
Internal iliac
Failure of fusion of the urogenital folds in a male causes what?
Hypospadias
Abnormal positioning of the genital tubercles in a male causes what?
Epispadias
Which drug puts a mom at risk for a placental abruption?
Cocaine
Placental abruption is pain___ while placenta previa (placenta covering the cervical os) is pain___.
Placental abruption is painful
Placenta previa is painless
What is vasa previa?
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
What HTN drugs are safe in pregnancy (+mnemonic)?
Hypertensive Moms Love Nifedipine
Hydralazine
Methyldopa
Labetalol
Nifedipine
What is HELLP syndrome? What do you see on peripheral smear?
A severe version of preeclampsia:
Hemolysis Elevated Liver enzymes Low Platelets
You will see schistocytes on smear
What drug is used to deliver the baby in ecamplsia and preeclampsia?
Magnesium sulfate
_______ is a grape-like mass emerging from a young girl (<4)’s vagina.
Sarcoma botryioides
How do koilocytes (seen in HPV-induced cervical cancer) appear on histology?
Cleared out cytoplasm with a thick basophilic rim and dark nucleus
The most common ovarian tumor is what? What cell type?
Serous cystadenocarcinoma
Fallopian tube-like epithelium
Present with psammoma bodies
they are often bilateral
How do fibroids change with pregnancy and menopause?
Increase with pregnancy (i.e. estrogen)
Decrease with menopause
___________ = fibrosis, calcifications in the acini and stroma of the breast lobules
Sclerosing adenosis
There is a slight increased risk of cancer
_________ hyperplasia is found in the lobules of the breast and is associated with increased risk of cancer if there are atypical cells.
Epithelial
What is fat necrosis in the breast?
Painless response to injury
Calcifications
Non-enzymatic
Giant cells
Fibroadenomas are completely benign and do NOT require treatment. Just reassurance!
Don’t forget
What is the primary side effect of Trastuzamab?
Cardiotoxicity
Which breast cancer causes “stippling of the skin”?
NOT referring to inflammatory carcinoma!
This is how they describe invasive ductal carcinoma
Varicoceles come from compressed what?
Pampiniform plexus
Which scrotal fluid accumulation DOES transilluminate?
Congenital hydrocele
What marker is elevated in seminomas?
ALP
placental alkaline phosphatase
Prostate cancer mets are osteo______.
Osteoblastic
Terbutaline and ritrodine are tocolytics used for:
Preventing premature birth
They are beta 2 agonists (terbutaline is also beta 1) causing uterine muscle relaxation.
Danazol is an older drug that is a synthetic androgen used to treat endometriosis and hereditary angioedema. It has what major side effect?
Pseudotumor cerebri that causes an increase in ICP leading to papilledema
^side note, vitamin A can also do this
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?
Sildenafil (Viagra) because it causes vasodilation and the combination can be life threatening.
