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Hormone Regulation and Reproduction > HRR Week 4 > Flashcards

HRR Week 4 Flashcards

1
Q

What physiological mechanism leads to the formation of male genitalia from bipotential embryonic tissue?

A

At 8 weeks, 5-alpha reductase converts testosterone to DHT (dihydrotesterone), which stimulates the development of male genitalia

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2
Q

What’s the physiology behind congenital adrenal hyperplasia?

A

The enzyme that converts cholesterol to cortisol is dysfunctional, leading to a compensatory overproduction of androgens

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3
Q

What cells are responsible for production of testosterone in the testes?

A

Leydig cells

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4
Q

What is the function of sertoli cells?

A
  • “Nurse” cells for sperm
  • Sensitive to FSH and regulate spermatogenesis
  • Secrete inhibin and androgen binding protein (which maintains high intra-tubular testosterone)
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5
Q

What’s the mechanism of action of Viagra (sildenafil)?

A

NO upregulates cGMP, leading to vasodilation and engorged tissues. Phosphodieserase type 5 (PDE5) is an enzyme that breaks down cGMP. Sildenafil inhibits this enzyme, thus sustaining high levels of cGMP.

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6
Q

True or false: you can maintain spermatogenesis after puberty with just testosterone and not FSH:

A

True. Both are needed for the first step in spermatogenesis, but only testosterone is needed for completion of meiosis.

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7
Q

True or false: migraines with or without aura are contraindicated for estrogen use.

A

False: only migraines with aura are contraindicated

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8
Q

True or false: estrogen is associated with increased clot risk.

A

True. Estrogen containing therapies are contraindicated in patients with a high risk of clots.

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9
Q

Diagnosis of abnormal pregnancy:

A

If HCG > 2000 (over-discriminatory zone):

  • No intrauterine pregnancy seen on US
  • May be “pseudo sac”

If HCG

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10
Q

How can SSRI’s be used to treat men with sexual issues?

A

Since SSRI’s are known to cause sexual side effects such as delayed ejaculation, they can be useful to treat men with rapid ejaculation.

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11
Q

Explain the PGE1 test:

A

Penile injection with prostaglandin E1. Wait 15 minutes and assess the level of erection. Can help diagnose the cause of erectile dysfunction.

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12
Q

What’s the test for urinary retention?

A

Post-void residual. Measured by scanner or catheterization. More than 100 mL is positive.

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13
Q

Primary locations for urethral stricture:

A

Bladder neck and bulbar urethra

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14
Q

Retrograde ejaculation is pathognomonic for what?

A

Urethral stricture

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15
Q

Screening worksheet used to assess symptoms of BPH:

A

AUA-SI (American Urological Association Symptom Index)

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16
Q

Treatment for BOO/BPH:

A
  • alpha blockers
  • 5-alpha reductase inhibitors
  • PDE5 inhibitors (taldanefil)
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17
Q

What drug might interfere with PSA interpretation?

A

Finasteride: reduces PSA by 50 - 60%

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18
Q

MOA for leuprolide (Lupron):

A

GnRH agonist: Binds to GnRH receptors without activating them, leading to decreased FSH and LH secretion and therefore less testosterone/estrogen.

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19
Q

Contraindications for Lupron:

A

Breastfeeding, pregnancy

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20
Q

Flutamide (Eulexin):

A

Androgen receptor antagonist: prevents transport into nucleus and blocks negative feedback on pituitary, leading to very high FSH/LH, which is why is must be administered with Lupron or goserelin. Used to treat prostate CA.

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21
Q

What can you administer to treat UTI as well as stress incontinence in women?

A

Topical estrogen

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22
Q

What is a pessary used for?

A

To treat stress incontinence in women

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23
Q

What’s one thing to worry about when treating nocturnal enuresis with DDAVP? What population would this not be recommended for?

A

Hyponatremia. Patients over 65.

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24
Q

What are the most common causes of post-menopausal uterine bleeding?

A
  • Atrophic endometrium
  • Endometrial polyp
  • Endometrial cancer
  • Hormonal effects
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25
Q

What lab would you draw for a postmenopausal patient suspected of having ovarian cancer?

A

CA125

Note: CA125 is not a screening tool for ovarian cancer. However, you should order it for ANY post-menopausal women with a pelvic mass.

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26
Q

What are BRCA1 and BRCA2 mutations a big risk factor for?

A

Ovarian cancer

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27
Q

What is Lynch syndrome a risk factor for?

A
  • Colorectal CA
  • Endometrial CA
  • Ovarian CA
    • others
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28
Q

Initial imaging in a patient with suspected ovarian cancer:

A

US or CT with contrast

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29
Q

In addition to pelvic masses, what exam finding is suggestive of ovarian cancer?

A

Ascites

30
Q

Definition and etiology of leiomyoma:

A

Benign tumor of smooth muscle cells of uterus (submucosal, subserosal, intramural). Etiology is unknown but estrogen is implicated in their growth

31
Q

Define CIN I, II, and III:

A

All ways of grading cervical changes as a result of HPV:

CIN I: mild dysplasia, correlates with LGSIL
CIN II: moderate dysplasia, correlates with HGSIL
CIN III: severe dysplasia, correlates with HGSIL

32
Q

Most common type of cervical cancer:

2nd most common:

A
  • Squamous cell carcinoma

- Adenocarcinoma

33
Q

Some red flags for cervical cancer:

A
  • Post coital bleeding
  • Fixed cervix
  • Watery, bloody, purulent or malodorous discharge
34
Q

What sort of imaging should be ordered for a patient suspected of having cervical cancer?

A

None. If the bimanual exam is abnormal, biopsy. Imaging is only used pre-surgically.

35
Q

What’s the curative treatment for cervical cancer?

A

Radiation

36
Q

What is a red flag for endometrial cancer?

A

Abnormal (ovulatory) uterine bleeding, or any bleeding in a post-menopausal woman

37
Q

Why is obesity a risk factor for endometrial cancer?

A

Adipose tissue secretes estrogen, and excess estrogen is the biggest risk factor for endometrial cancer.

38
Q

Risk factors for endometrial cancer:

A
  • Obesity
  • Tamoxifen use
  • Chronic anovulation
  • Long term exposure to estrogen
  • Lynch syndrome or other genetic d/o
39
Q

Describe type II endometrial cancer:

A
  • Not estrogen dependent
  • Atrophic endometrium
  • Higher grade, poor prognosis
40
Q

What’s the relationship between cigarettes and endometrial cancer?

A

Smoking actually helps endometrial cancer!

41
Q

What’s the most deadly gynecologic cancer?

A

Ovarian cancer. Usually not caught until stage 3 or 4, at which point there’s already a poor prognosis.

42
Q

Risk factors for ovarian cancer:

A
  • Cigarettes (mucinous type only)
  • Early menarche/late menopause (more lifetime ovulations)
  • PCOS
  • BRCA I,II, Lynch syndrome
  • Obesity
  • Nulligravidity
  • Age
  • Infertility
  • Endometriosis
43
Q

Protections against ovarian cancer:

A
  • Having kids
  • OCPs
  • Breast feeding
  • Gynecologic surgery
44
Q

What’s the initial imaging modality or suspected ovarian cancer?

A

Transvaginal ultrasound. CT is second choice.

45
Q

What are the ACOG guidelines for referral to a gynecological oncologist for pelvic mass?

A
  • CA125 over 200
  • Ascites
  • Evidence of distant metastases
46
Q

True or false: you should never biopsy an ovary.

A

True

47
Q

Etiologies for vulvar cancer:

A
  • HPV mediated
  • Autoimmune
  • Melanoma 2nd most common histology, so pay attention to moles
48
Q

Describe the etiology and SSx of vaginal cancer:

A
  • HPV mediated SCC
  • Can be flat plaque, mass or ulcer, usually on posterior wall
  • Post-coital bleeding or other bleeding
49
Q

What’s unique about gestational trophoblastic diseases?

A
  • They all arise from fetal tissue after an abberrant fertilization event.
  • Are highly curable by chemotherapy
  • Secrete hCG
50
Q

Hydatidiform mole:

A
  • Benign but may be locally invasive
  • Highest incidence in younger than 20, older than 40, nulliparous, nutrient deficient, low socioeconomic women.
  • Type O father with type A mother increases risk, AB mother has worse prognosis
51
Q

Choriocarcinoma:

A
  • In about half the cases, arises from a hydatidiform mole
  • Often presents as late post-partum vaginal bleeding
  • Enlarged uterus, ovaries, vaginal lesions on PE
52
Q

Red flags for gestational trophoblastic disease?

A
  • 1st trimester pre-eclampsia
  • 1st trimester AUB
  • Enlarged ovaries, abnormal uterine size for gestational age
53
Q

Imaging modality and findings for gestational trophoblastic disease:

A
  • US
  • “Snowstorm” pattern of hypoechoic areas
  • No gestational sac or fetus
54
Q

When might you used estriol vs estrodiol?

A

To treat symptoms of menopause. Estriol has less estrogenic potential than estradiol.

55
Q

TAHBSO:

A

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

56
Q

Uses for therapeutic estrogen:

AEs:

A
  • Tx of primary hypogonadism or surgical menopause
  • HRT
  • Contraception (with progestin)

AEs: Can mimic the symptoms of pregnancy: nausea, breast tenderness, bleeding, thromboembolism, endometrial cancer

57
Q

What is a good use of Estring (estradiol ring)?

A

Vaginal atrophy. The low dose of estrogen avoids many of the symptoms of larger dose Premarin, but is still sufficient for vaginal atrophy.

58
Q

When should you use a combination estrogen/testosterone therapy?

A

In patients who have failed estrogen/progesterone therapy

59
Q

Pharmacologic treatments for prostate cancer:

A
  • GnRH agonists: Lupron (leuprolide)
  • Estrogen: Premarin
  • Anti-androgens: Eulexin (flutamide). Can only be used in conjunction with Lupron.
60
Q

Other uses for Lupron:

A
  • Breast cancer treatment

- Endometriosis

61
Q

Treatment for bacterial vaginosis:

A
  • Metronidazole (Metrogel or Flagyl)
  • Possible disulfuram rxn so avoid alcohol
  • Also approved for trichomonas
62
Q

Risks associated with depo provera:

A
  • Reduced bone mineral density
  • Irregular bleeding
  • Weight gain
  • Amenorrhea
63
Q

What’s the primary estrogen produced by the body after menopause?

A

Estrone

64
Q

When should you consider prescribing a progestin-only OCP?

A

Older smokers or women at risk of thromboembolism, or for whom estrogen is contraindicated.

65
Q

True or false: progestin-only contraceptives increase the risk of ectopic pregnancy.

A

True

66
Q

Which treatment for BPH do you need to watch out for orthostatic HTN with?

A

Alpha blockers (the “osin” drugs) such as tamsulosin (Flomax).

67
Q

What’s a common and unusual side effect of Phenazopyridine (pyridium)?

A

Can cause urine to be red/orange

68
Q

What class of drugs are useful for treating urinary incontinence?

A

Anticholinergics: tolteradine (Detrol LA), oxybutynin (Ditropan), trospium chloride (Sanctura)

69
Q

Medical treatment for spontaneous abortion:

A

Misoprostol: induces uterine contractions and expulsion of products of conception.

70
Q

Low progesterone levels (less than 5 ng/mL) measured during pregnancy suggest what?

A

Abnormal pregnancy

Hormone Regulation and Reproduction (4 decks)

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