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USMLE STEP 2, for real tho > Naz teaches infertility > Flashcards

Naz teaches infertility Flashcards

1
Q

Most likely cause of anovulation

A

PCOS

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2
Q

Labs of PCOS

A

↑ Lh/ FSH ratio (LH> FSH)

↑ Testosterone

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3
Q

What is infertility

A

cannot get pregnant for 1 year (pts over 35 get worked up quicker)

80% of couples get pregnant in one year

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4
Q

What makes GnRH

A

Hypothalamus

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5
Q

When is HCG made

A

hCG secretion begins around the time of
implantation of blastocyst.

Blastocyst “sticks” at day 6

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6
Q

When does the heart beat?

A

4 weeks

also upper and lower limb buds begin to form.

4 weeks = 4 limbs and 4 heart chambers

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7
Q

When can you see the heartbeat on US

A

6 weeks

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8
Q

Aminoglycosides do what to baby

A

ototoxic

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9
Q

When do you measure FSH

A

Day 3 labs
(3 days into period)

Day 3 labs are
FSH and estradiol levels, AMH levels, and AFC).

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10
Q

What test do you do to see if you ovulate

A

LH surge at home urine kit

Basal body temperature (↑ progesterone –> ↑ temp)

if progesterone is low, so is fertility

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11
Q

Estrogen stimulates __________

A

endometrial proliferation.

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12
Q

Progesterone does?



A

maintains endometrium to support implantation.

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13
Q

Oligomenorrhea is

A

> 35-day cycle.

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14
Q

Polymenorrhea is?

A
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15
Q

Metrorrhagia

A

Frequent or irregular menstruation.

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16
Q

Menorrhagia

A

Heavy menstrual bleeding; > 80 mL blood loss or > 7 days of menses.

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17
Q

Menometrorrhagia

A

Heavy, irregular menstruation.

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18
Q

Day 21 serum progesterone labs help because?

A

Basal body temperature (↑ progesterone –> ↑ temp)

if progesterone is low, so is fertility

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19
Q

Ovarian causes of infertility

A
  • PCOS
  • Advanced maternal age
  • Premature ovarian failure
  • Hypothalamic amenorrhea
  • Hyperprolactinemia
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20
Q

Tubal factors of infertility

A
  • PID/ salpingitis
  • Tubal ligation
  • Endometriosis
  • Pelvic adhesions
21
Q

Uterine factors of infertility

A
  • Congenital malformations
  • Submucosal fibroids
  • Uterine polyps
  • Intrauterine synechiae (Asherman’s syndrome)
22
Q

Cervical factors of infertility

A
  • Müllerian duct abnormalities
  • Cervical stenosis
  • Cervicitis or chronic inflammation
23
Q

List the Medications Used in the Treatment of Infertility and in Assisted Reproductive Technologies

A
  • Clomiphene citrate
  • Metformin
  • HCG
  • Pulsatile GnRH/ gonadorelin
  • Letrozole
24
Q

Letrozole is?

A

Aromatase inhibitor,
reduces androgen conversion to estrogen,
stimulates follicular development for ovulatory induction

25
Q

gonadorelin is?

A

GnRH agonist, stimulates release of FSH/LH from pituitary

26
Q

Novarel is?

A

Human chorionic gonadotropin

Similar structure to LH, triggers ovulation after gonadotropin folliclestimulation

27
Q

metformin helps get pregnant via?

A

Insulin sensitizer, decreases insulin,testosterone, BMI; promotes ovulation

28
Q

Clomiphene citrate is

A

Anti-estrogen, stimulates follicular development for ovulation induction

29
Q

Day 3 labs are:

A

FSH and estradiol levels, AMH levels, and AFC

30
Q

Clomiphene citrate works via?

A
  • antiestrogen, binds to estrogen receptors in the hypothalamus–>
  • ↑ FSH and LH –>
  • follicular maturation and ovulation
31
Q

Clomiphene citrate is best used for?

A

women with chronic anovulation or mild hypothalamic insufficiency after specific causes of hypothalamic dysfunction have been ruled out.

32
Q

Human menopausal gonadotropins are used for?

A

a form of FSH, or FSH + LH

directly stimulate follicular maturation in patients for whom Clomid has failed,

33
Q

ovarian Hyper-stimulation syndrome

A

Very dangerous

fertility stuff–> ovarian enlargement, torsion, and rupture

34
Q

Risk factors for endometrial carcinoma include

A 
nulliparity
late menopause
 hypertension
 exposure to unopposed estrogens. 
*obesity confers the greatest risk of developing endometrial carcinoma,
35
Q

Approximately 80-90% of women with endometrial carcinoma present with ?

A

vaginal bleeding or discharge as their only presenting symptom

36
Q

Top Five Cancers Detected in Women:

A 
Breast	28%
Lung	14%
Colon	10%
Uterine 6%
Ovary	3%
37
Q

Risk factors for endometrial cancer include

A 
late menopause
 unopposed estrogen therapy
 nulliparity
obesity
Tamoxifen therapy
diabetes mellitus.
38
Q

Unopposed estrogen replacement therapy does increase the risk of endometrial cancer, but not when?

A

taken in combination

39
Q

Routine eval for endometrial ca would include

A

chest x-ray- lungs most common site for mets

40
Q

The recommended components of the surgical approach to an early endometrial cancer are ?

A

extrafascial total abdominal hysterectomy
bilateral salpingo-oophorectomy
pelvic and para-aortic lymphadenectomy.

41
Q

The most common causes of postmenopausal bleeding are

A 
atrophy of the endometrium (60-80%)
hormone replacement therapy (15-25%)
 endometrial cancer (10-15%)
polyps (2-12%)
hyperplasia (5-10%).

Any history of vaginal bleeding requires assessment of the endometrium.

42
Q

Tamoxifen is known to cause changes to the endometrium, including?

A

thickening
thus US does not help you eval if apt is getting CA from the drug
If they do get CA, likely to show symptoms

43
Q

Dermoid tumors usually have solid components or appear echogenic on ultrasound, as they may contain ?

A

teeth, cartilage, bone, fat and hair

44
Q

An intravenous pyelogram (IVP) is an x-ray examination of the?

A

kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins.

45
Q

The most likely diagnosis of the adnexal mass that would also explain the finding of endometrial hyperplasia would be a?

A

granulosa cell tumor (sex-cord stromal tumor)

46
Q

In all patients with advanced ovarian cancer, post-operative chemotherapy with a combination of _______________- is considered standard of care in the United States.

A

a taxane and platinum adjunct

47
Q

The most common tumor found in women of all ages is the ?

A

dermoid. The median age of occurrence is 30 years, and 80% occur during the reproductive years. Dermoids may contain differentiated tissue from all three embryonic germ layers.

48
Q

dermoid median age of occurrence is ?

A

30 years, and 80% occur during the reproductive years.

49
Q

Dermoids may contain?

A

differentiated tissue from all three embryonic germ layers.

Dermoid tumors can contain teeth, hair, sweat and sebaceous glands, cartilage, bone, and fat.

USMLE STEP 2, for real tho (16 decks)

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