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USMLE S1 > O&G > Flashcards

O&G Flashcards

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USMLE® Step 1 flashcards
1
Q

first line Rx PCOS

A

weight loss - improves androgen symptoms and returns regular menses

metformin (if diabetic/prediabetic)

COCP - reduces endometrial hyperplasia, reduce hirsuitism & acne, prevent pregnancy (unwanted)

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2
Q

what CA?

A

granulosa cell tumour of ovary

  • cuboidal cells in sheets with coffee-bean nuclei arranged in microfollicular structure around pink, eosinophilic centre*
  • yellow theca cells with lipid*
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3
Q

Gestational Choriocarcinoma

  • benign/malignant
  • trophoblast
  • villi
  • foetal/embryonic tissue
A
  • malignant
  • diffusely anaplastic, necrotic with vascular invasion
  • absent
  • present or absent
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4
Q

in postpartum haemorrhage, failure of haemostasis with uterotonic agents suggests what?

A

retained placenta/placenta accreta

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5
Q

Rx HSV-2 gential herpes

A

acyclovir, famciclovir, valacyclovir

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6
Q

diagnosis?

A

immature teratoma

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7
Q

three aetiologies of congenital toricollis

A
  1. foetal malposition & oligohydramnios
  2. traumatic delvery (e.g. breech presentation)
  3. [rarely] Cervical spine abnormality
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8
Q

2 major risk factors for cervical CA/CIN

A

lack of barrier contraception

++ lifetime sexual partners

both HPV-16/18 mediated

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9
Q

Rx bacterial vaginosis

what bug?

A

metronidazole and clindamycin

Gardnerella vaginalis

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10
Q

diagnosis?

A

mature teratoma

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11
Q

oral contraception, multiparity, breastfeeding all reduce risk of what cancer?

what is the common mechanism?

A

epithelial ovarian CA

reduction in the frequency of ovulation, reduction in ovarian surface trauma, reduction in ovarian surface repair, reduction in malignant transformation potential

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12
Q

Invasive mole

  • benign/malignant
  • trophoblasts
  • villi
  • foetal/embryonic tissue
A
  • malignant
  • diffusely hypertrophic with myometrial invasion
  • diffusely enlarged, hydropic
  • absent
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13
Q

Partial mole

  • benign/malignant
  • trophoblasts
  • villi
  • foetal/embryonic tissue
A
  • benign
  • focally hyperplastic
  • focally enlarge, hydropic
  • present, triploid
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14
Q

define mature and immature teratoma

A

mature = benign, contain cell types from >1 germ layer

immature = malignant, mature cell type from all 3 germ layers and immature (embryonic, not foetal) tissue from at least one germ layer (usually neuroectoderm)

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15
Q

if a woman wants to get pregnant, Rx PCOS

A

weight loss

metformin (if diabetic/pre-diabetic)

estrogen receptor modulator (clomiphine/letrozole) - reduces estrogen/ER negative feedback in hypothalamus resulting in increased gonadotroph stimulation of ovaries –> ovulation

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16
Q

3 associated abnormalities with congenital torticollis

A
  1. hip dysplasia
  2. club foot (tapies equinovarus)
  3. metatarsus adductus (foot adduction)
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17
Q

define congenital torticollis

A

pathologic contracture of SCM muscle in infant resulting in fixed flexion deformity from muscular injury and fibrosis

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18
Q

Complete mole

  • benign/malignant
  • trophoblast
  • villi
  • foetal/embryonic tissue
A
  • benign
  • diffusely hyperplastic
  • diffusely enlarged, hydropic
  • absent
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19
Q

gynae CA precocious puberty, endometrial hyperplasia large unilateral adnexal mass elevated serum Inhibin-alpha

A

granulosa cell tumour of the ovary

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20
Q

elevated maternal AFP suggests what (3)?

A
  1. neural tube defect
  2. ventral wall defect
  3. mutliple gestation
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21
Q

decreased maternal AFP suggests what (2)?

A
  1. aneuploidy (21, 18, 13)
  2. incorrect dating
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22
Q

decreased maternal uE3 suggests what?

A

placental abnormalities and IUGR

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23
Q

infundibulopelvic ligament/suspensory ligament of the ovary

what does it connect and what does it contain?

surgical importance

A

ovaries to the pelvic wall

ovarian vessels

ligate suspensory ligament during oophorectomy - ureters run close by so at risk of damage during ligation

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24
Q

cardinal ligament

connects what structures and contains what structures

surgical consideration

A

cervix to the pelvic wall

uterine vessels

ligation during hysterectomy, risk of damage to ureter during ligation

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25
Q

round ligament

connects what structures, contains what structures

surgical considerations

A

fundus of uterus, through the inguinal canal, to labia majora

contains nothing

travels above the artery of Sampson (insignificant, just know that it’s going to bleed)

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26
Q

broad ligament

connects what structures, contains what structures

A

fallopian tubes, ovaries and uterus to pelvic wall

fallopian tubes, ovaries and round ligament

comprised of mesosalpinx, mesovarium, mesometrium

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27
Q

ovarian ligament

connects what structures, contains what structures

A

medial pole of the ovary to the lateral wall of the uterus

contains nothing

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28
Q

what are the two ligamentous derivatives of the gubernaculum

A

round ligament of uterus

ovarian ligament

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29
Q

rank the potency of the different estrogens

where are they mainly produced?

A

estradiol > estrone > estriol

E1 - adipose tissue (via aromatization)

E2 - ovary

E3 - placenta

30
Q

effect of oestrogen on circulating lipids

A

increase HDL

decrease LDL

(severe increase in CV risk for women post menopause)

31
Q

physiological sources of progesterone

A
  • corpus luteum (early pregnancy)
  • placenta (late pregnancy)
  • adrenal cortex
  • testes
32
Q

how does progesterone prevent pregnancy? (2)

A
  1. inhibition of gonadotrophins (LH and FSH)
  2. cervical mucus thickening preventing sperm entry to uterus
33
Q

what is Mittelschmerz?

mechanism?

A

mid-cycle ovulatory pain

swelling and rupture of the follicle irritates the peritoneum. contraction of the fallopian tube can cause colicky pain.

can mimic appedicitis

34
Q

which menstrual phase is always constant?

A

luteal phase.

once the follicle has ruptured/ovulation occured, it is always 14 days until menstruation

35
Q

what uterine phase occurs during the luteal phase of the menstrual cycle?

A

secretory

36
Q

what uterine phase(s) occur(s) during the follicular phase of the menstual cycle?

A

menses & proliferative phase

37
Q

define low birth weight

A

birth < 2500g

38
Q

what are the parts of the fallopian tube?

A

fimbrae, infundibulum, ampulla, isthimus, (uterotubal junction), intramural segment, ostium

39
Q

when can you use a home pregnancy test?

A

at least 2 weeks following conception

when urine beta-HCG levels are high enough for detection.

betaHCG can be detected on blood by 1 week after conception

40
Q

what are the placental hormones? (5)

which placental hormone decreases before the end of pregnancy?

A

progesterone, prolactin, betaHCG, estriol, human placental lactogen

betahCG - peak 8 - 10 weeks, minimal by 20 weeks

41
Q

elevated hCG suggests what?

falling hCG suggests what?

A

multiple gestation, GTD, Down’s syndrome

Trisomy 13/18, ectopic pregnancy, failing pregnancy

42
Q

how does pregnancy cause hyperthyroidism?

A

alpha subunit of hCG is identical to TSH. (also FSH and LH)

cross-activation of TSH receptor leads to increased T4

43
Q

what must be supplemented with exclusively breast fed infants?

A

vitamin D

44
Q

definition of premature ovarian failure?

A

premature atresia of ovarian follicles after puberty but before 40 years old

leads to early menopause, - oestrogen, + LH, ++FSH

45
Q
A
46
Q

what is the cellular mechanism by which HPV causes CIN?

A

HPV genes incorporated into host genome, production of proteins E6 and E7

inhibition of p53 and RB (respectively) cell cycle regulators

47
Q

serum betaHCG is detectable on what day following fertilisation?

A

day 8

48
Q

what are the four aetiologies for polyhydramnios?

A
  1. impaired swallowing: GI obstruction, anencephaly
  2. high foetal cardiac output: alloimmunisation (twin-to-twin transfusion syndrome), PVB19 infection, foetomaternal haermorrhage
  3. maternal diabetes (milder)
  4. multiple pregnancy (milder)
49
Q

most common intrauterine configuration for dizygotic twins?

A

DCDA always

50
Q

most common configuration for monozygotic twins

A

MCDA

51
Q

failure of separation of monozygotic twins until day 8-12 results in what?

A

MCMA twins

high foetal fatality because of umbilical cord entanglement

52
Q

failure of separation of monozygotic twins until day 13 likely results in what?

A

MCMA conjoined twins

53
Q
A
54
Q

another name for the Mullerian ducts?

describe the embryology in women, with 3 defects

A

paramesonephric ducts

  • gives rise to fallopian tubes, uterus, cervix and upper vagina
  • dependent on lateral and vertical fusion and involution of PMN ducts
  • incomplete lateral fusion = bicornuate uterus
  • total lack of fusion = didelphys uterus (double uterus & cervix)
  • failure of involution = longitudinal intrauterine septum
55
Q

HSG reveals uterine central filling defect

how do you tell the difference between septate and bicornuate?

A

MRI assessing the fundal outer uterine contour

56
Q

what is Mayer-Rokitansky-Kuster-Hauser syndrome?

A

complete agenesis of Mullerian ducts

lower vagina generated from urogenital sinus but ends in blind pouch, total infertility

57
Q

failure of vertical fusion of the Mullerian ducts leads to what?

A

transverse septum between the upper and lower vagina, where the Mullerian duct and urogenital sinus meet

Leads to primary amenorrhoea, haematometria and cyclic menstrual pain

58
Q

what is the first line management for stres urinary incontinence

A

lifestyle modifications

  1. dietary fibre to reduce straining
  2. Kegel exercises to strengthen levator ani
59
Q

fever and localised pelvic pain one week after delivery

what is the non-infective differential diagnosis here?

A

ovarian vien thrombosis

usually admitted to hospital with presumed infection, treated with Abx empirically but then no growth on cultures.. CT/MRI reveals thrombus in ovarian vein which may extend to IVC

60
Q

what is the pathogenesis of peau d’orange?

A

malignant cell invasion of cutaneous lymphatic drainage, lymphoedema

61
Q

what is this cell called and what does it indicate?

A

koilocyte

HPV infection found on cervical smear

immature squamous cell, dense irregularly staining cytoplasm. Perinuclear clearing. Pyknosis/’raisin appearance’

62
Q

in fertility therapy, what is the role of menotropin?

A

Menotropin = human menopausal gonadotrophin (FSH)

mimic FSH during the follicular phase, establish a dominant ovarian follicle

Followed by single shot of hCG (mimic LH surge) which causes follicle rupture and ovum release

63
Q

what are the signs/clinical features of ovulation?

A
  1. loss of dominant follicle on TA USS
  2. surge urine LH
  3. increased serum progesterone
  4. rise in basal body temperature
64
Q

what are the steps in oestrogen and progesterone synthesis in the ovary?

A

theca interna - cholesterol to progesterone and androgens, stimulated by LH

granulosa cells - conversion of androgens to oestrogen by aromatase, stimulated by FSH

65
Q

what are the effects of anovulatory cycles (usually in teenage girls)?

A

anovulation = no corpus luteum

no progesterone, constantly high oestrogen levels

chronic proliferative endometrium - disorganised and fragile

intermenstrual bleeding, disorganise and heavy menstrual bleeds

in teenagers -> HPA axis will mature and anovulation will remit naturally. Returns at the beginning of menopause due to ovarian exhaustion

66
Q

what is the main action of progesterone on the endometrium during a regular cycle (pre-implantation)

A

to differentiate the proliferative (estrogen) endometrium into the secretory endometrium which is more hospitable for implantation

67
Q

PCOS sequellae?

A

type II DM

endometrial hyperplasia and adenocarcinoma (unopposed action of oestrogen)

68
Q

17alpha-hydroxylase, 17,20 lyase and 3beta-hydroxysteroid dehydrogenase are all increased in what disease?

What are the hormonal consequences?

A

PCOS

overexpression leads to increased androgen levels (testosterone, DHEA, androstenedione)

hirsuitism and acne; prevention of dominant follicle so no progesterone

69
Q

what is the main factor contributing to gestational diabetes?

A

human placental lactogen (hPL)

70
Q

what are the main physiologic roles of hPL?

A
  1. increase insulin resistance - increase circulating glucose for foetal fule, stimulate lipolysis to provide ketones as fuel in lieu for mother
  2. increase maternal pancreatic insulin secretion - as mother becomes insulin resistant she needs to increase circulating insulin to overcome this

effects are more prominent as the gestation progresses, reflecting the increasing nutritional demand of the foetus

71
Q

at what week gestation does the alimentary canal finish canalization?

A

9th week

USMLE S1 (16 decks)

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