Prolog Flashcards
Fructose, the energy source in sperm, is absent in cases of
obstructive azoospermia
number one genetic cause of premature ovarian failure
Fragile X
how long after bariatric surgery to wait for pregnancy?
12-18 months
Oral contraceptives can reduce the risk of ovarian cancer by approximately __% in BRCA1 mutation carriers
50%
Women with exercise-induced amenorrhea have __ leptin levels than ovulatory females
lower
normal AMH
1.5 - 6ish
Initial evaluation of premature thelarche should include (labs)
blood estradiol and TSH levels and bone age
whole arm exchange between acrocentric chromosomes =
robertsonian translocation
administration of cyclic progesterone for a patient with polycystic ovary syndrome mimics
involution of the corpus luteum
Which is better in pregnancy, bromocriptine or cabergoline?
Cabergoline
A thrombophilia panel is indicated when losses occur after __ weeks, when __
10 weeks
when thrombosis can occur in the vasculature of the placenta.
treatment for postpartum thyroiditis
observation
Postpartum thyroiditis almost exclusively affects
thyroid antibody-positive women.
The ovulation induction medication most likely to result in high-order multiple gestation
gonadotropin
The most common form of congenital adrenal hyperplasia is deficiency in
21-hydroxylase
genetic inheritance of CAH
autosomal recessive
A small percentage of patients with CAH may be hyper- tensive secondary to mineralocorticoid deficiency. These patients typically have a deficiency in __ enzyme
11β-hydroxylase
Patients who fail to achieve puberty, who are hyper- tensive, or who have primary amenorrhea should be evaluated for __ deficiency
17α-hydroxylase
cutaneous pigmentations, polyostotic fibrous dysplasia, and multiple endocrine abnormalities
McCune Albright syndrome
child walking with limp, hyperpigmented lesions on skin, low LH and FSH
McCune Albright syndrome
treatment for McCune Albright
aromatase inhibitor
Children with premature adrenarche are more likely to develop adult
PCOS
Evaluation for premature adrenarche includes (6 labs)
DHEAS, FSH, LH, testosterone, TSH, and morning 17-hydroxyprogesterone
2 benign conditions of the ovary that are unique to pregnancy and lead to hirsutism and virilization
Ovarian luteoma
hyperreactio luteinalis
the presence of multiple theca-lutein cysts bilaterally due to hCG stimulation
Hyperreactio luteinalis
HRT risks in study
increased risk of stroke in estrogen only and E+P
increased risk of stroke, cardiac, breast cancer in E+P
only environmental factor proven to impact SA and and ferility
hot tub use
men heterozygous for CF have congenital absence of
vas deferens
the best chance for conception is on the day of
LH surge
Deficiency in __ secretion is a serious condition associated with Sheehan syndrome
ACTH
Because adrenal insufficiency can result in a life-threatening adrenal crisis
how to test for adrenal insufficiency
early-morning serum cortisol levels
The technique associated with IVF most likely to identify a genetically normal ongoing pregnancy is
trophectoderm biopsy
most common EMB finding in PCOS with heavy bleeding
disordered proliferative endometrium
What imaging should you use for the detection of uterine anomalies?
three dimension ultrasound
28-year-old nulligravid woman comes to your office with primary infertility. She has regular menstrual cycles. Hysterosalpingography is normal. Her partner’s repeat semen analysis confirms oligospermia. Physical examination demonstrates palpable varicoceles when standing and with Valsalva maneuver. The best next step in management for the male partner is
varicocelectomy
Ashkenazi Jewish 23-year-old nulligravid woman visits your office with irregular menstrual cycles. She is interested in becoming pregnant. She has seen her dermatologist for acne and hirsut- ism and has been shaving her chin weekly for the past 10 years. On physical examination, she has acne on her face and mild hair growth on her upper lip and chin. She shows no signs or symptoms of virilization.
Late-onset congenital adrenal hyperplasia (or nonclassic adrenal hyperplasia) — onset of hirsutism around menarche
how to diagnose late onset CAH
morning follicular 17α-hydroxyprogesterone
mutation in Late-onset congenital adrenal hyperplasia
50–80% loss of 21-hydroxylase activity (P450c21 enzyme) due to mutations in the CYP21A2 gene
most common tumor that causes central precocious puberty
hypothalamic hamartoma
What happens in hypothalamic hamartoma
astroglial cells within the tumor release transform- ing growth factor-beta protein to induce GnRH release from the hypothalamus
three syndromes that cause peripheral precocious puberty
McCune–Albright syndrome
Peutz-Jeghers syndrome
silver-russell syndrome
normal FSH levels
midcycle peak 15-35
postmenopause 24-170
describe Fragile X mutations
dynamic trinucleotide repeat (CGG) sequence mutation in the X-linked FMR1 gene at the terminal end of the long arm of the X chromosome
19-year-old nulligravid woman comes to your office with primary amenorrhea. She is 1.75 m (69 in.) tall with Tanner stage 1 breast development and Tanner stage 3 pubic hair. Her follicle- stimulating hormone level is 52 mIU/mL. Her endocrine screening is otherwise normal. Her karyotype is 46,XY
diagnosis?
Swyer syndrome
19-year-old nulligravid woman comes to your office with primary amenorrhea. She is 1.75 m (69 in.) tall with Tanner stage 1 breast development and Tanner stage 3 pubic hair. Her follicle- stimulating hormone level is 52 mIU/mL. Her endocrine screening is otherwise normal. Her karyotype is 46,XY
Next step?
gonadectomy
frequency with which patients will have at least one patent fallopian tube at 3 months after Essure microinsert placement is
less than 5%
Male Secondary hypogonadotropic hypogonadism can be caused by __ and __.
obesity and anabolic steroids
how to achieve pregnancy in Kallman syndrome
human menopausal gonadotropins
The most accurate way to evaluate insulin resistance in patients with PCOS is
hyperinsulinemic euglycemic clamp
DHEAS is almost exclusively derived from __
the adrenal glands
Name 4 commonly used bisphosphonates
alendronate sodium, ibandronate sodium, risedronate sodium, and zoledronic acid.
The earliest test that will identify a diminished ovarian reserve is
AMH
hyperandrogenism in pregnancy with bilateral ovarian enlargement, multicystic ovaries
hyperreactio luteinalis (multiple benign theca-lutein cysts)
A 19-year-old woman with primary amenorrhea and lack of breast development visits your clinic. She is 1.73 m (68 in.) tall and weighs 63.5 kg (140 lb). On physical examination, she has Tanner stage 1 breast development and Tanner stage 1 pubic hair. Genital examination reveals a cervix. Her follicle-stimulating hormone and luteinizing hormone levels are 76 mIU/mL and 64 mIU/mL, respectively. Her estradiol level is less than 20 pg/mL. The most likely diagnosis is
Swyer
Individuals with Kallmann syndrome typically have__ gonadotropin levels.
low
relative to laparoscopic-assisted surgery, robotic-assisted surgery increases her risk of
small-bowel obstruction
how to diagnose Cushing syndrome
overnight dexamethasone suppression test
FDA)-approved bioidentical hormone prescribed for menopausal symptoms
17β-estradiol
time that the window of fertilization ends is
the day of ovulation
The type of stem cells that presently hold the most promise for stem cell-based therapy for infertile patients is
induced pluripotent
the sterilization method most amenable to surgical reversal is
laparoscopic application of a band or clip
Criteria Used to Calculate the 5-Year Risk of Breast Cancer According to the Modified Gail Model
age, age at menarche, age at first live birth, number first degree relatives w breast cancer, number previous breast biopsies, whether any breast bx has shown atypical hyperplasia, race
karyotype and serum T level for: Complete androgen insensitivity syndrome (CAIS)
46,XY karyotype and serum testosterone in the male range
karyotype and serum T level for: Pure gonadal dysgenesis (Swyer syndrome)
46,XY karyotype and serum testosterone in the female range
karyotype and serum T level for: Trisomy X syndrome
47,XXX karyotype and serum testosterone in the female range
most likely genetic disorder: A 53-year-old woman was recently diagnosed with breast cancer. She has a paternal grandmother with breast and ovarian cancer and a father with prostate cancer. She is most likely to have a mutation associated with a region in exon 11 of the mutated gene.
BRCA2 mutation
most likely genetic disorder: Autosomal dominant disorder associated with mutations of the STK11 gene that causes tumors of the gastrointestinal tract, breast, ovary, cervix, and testis as well as mucocutaneous pigmentation.
Peutz–Jeghers syndrome
most likely genetic disorder: Germline mismatch mutation of the MLH6 gene that confers a higher risk of endome- trial cancer and a slightly lower risk of colorectal cancer compared with MLH1 and MSH2 mutations.
Lynch II syndrome, ie, hereditary nonpolyposis colorectal cancer
Corticosteroids increase placental production of this hormone
Corticotropin-releasing hormone (CRH)
Human placental lactogen is a product of the placenta and has __like activity.
growth hormone
most likely circulating serum level of LNG in pg/mL: 30-microgram ethinyl estradiol with 150-microgram LNG oral contraceptive (OC) pill 24 hours after ingestion
2,000–3,000
most likely circulating serum level of LNG in pg/mL: Single-dose progestin-only emergency contraceptive 2 hours after ingestion
10,000–15,000
most likely circulating serum level of LNG in pg/mL: A 5-year LNG intrauterine device (IUD)
100–200
likely diagnosis for a woman with hirsutism and High 24-hour urinary free cortisol
Cushing syndrome
likely diagnosis for a woman with hirsutism and Total testosterone level of 300 ng/dL Follicular phase morning blood tests showing 17-hydroxyprogesterone level of 488 ng/dL
Sertoli–Leydig cell tumor
laparoscopic surgery with Tachycardia, hypoxia, hypotension, and decreased end tidal carbon dioxide (CO2)
Gas embolism
