random repro facts

Question 1

how do you differentiate endometriosis from adenomyosis?

Answer 1

Adenomyosis has an enlarged uterus.

Question 2

Gestational trophoblastic disease: 3 types, features.

Answer 2

• Hyatidiform moles: nonviable fertilized egg implants. Vaginal bleeding, abdominal pain.
  
  • Complete mole - egg loses DNA, sperm duplicates (or 2 sperm) - 46YY.
    
    • Fetal tissue absent, trophoblast only; hydropic vili are “bunch of grapes”
    • Can present with hyperthyroidism, pre-eclampsia, theca-lutein cyst, hyperemesis
    • High risk of malignant trophoblastic dz
  • Partial mole - triploid - usually 69XXX or 69 XXY.
    
    • Some fetal tissue present; some grossly enlarged vili
    • Low risk of malignant dz
  • “Missed abortion” - most will proceed to abortion spontaneously
  • Suction curettage and beta-HCG followup monitoring
  • Invasive mole - does not resolve spontaneously
• Choriocarcinoma - extensive metastases but responsive to chemotherapy

Question 3

What is the time course from fertilization to implantation?

Answer 3

1. Morula (3-4days) enters uterus
2. 6 days: implantation and b-hCG production
3. somewhere in 6-11 days after ovulation: can detect b-hCG.

Question 4

Torticollis - presentation and causes

Answer 4

Infant prefers to hold head to one side after 2-4 wks

Due to malposition of fetus or injury during birth, SCM muscle fibroses and contracts.

Associated with hip dysplasia, clubfoot.

Presents as painless firm mass.

Question 5

Most common cause of fetal hydronephrosis?

Answer 5

Inadequate canalization of ureteric bud. Obstruction at ureteropelvic junction.

Vesicoureteral obstruction not as common.

Posterior urethral valve is bilateral and not as common.

Question 6

APGAR - what does it stand for, significance?

Answer 6

Appearance, Pulse, Grimace, Activity, Respiration.

If < 4, resuscitate

4-6 assist and stimulate

<4 risks long term neuro damage

Question 7

Developmental milestones - infancy - motor

Answer 7

• Primitive reflexes disappear
  
  1. Moro reflex - 3 mo
  2. Rooting reflex - 4 mo
  3. Palmar reflex - 6 mo
  4. Babinski reflex - 12 mo
• Posture
  
  1. Holds head up - 1 mo
  2. Sits up - 6 mo
  3. Rolls/crawls - 8 mo
  4. Stands - 10 mo
  5. Walks - 12-18mo
• Picks
  
  1. Passes toys from hand to hand - 6 mo
  2. Pincer grasp - 10 mo
  3. Points to objects - 12 mo

Question 8

Developmental milestones - motor - Toddler

Answer 8

• Climbs stairs (18 mo)
• Cube stacking (age x 3)
• Cultured - eats with fork (20 mo)
• Kicks ball (24 mo)

Question 9

Developmental milestones: social and verbal/cognitive - infant

Answer 9

• Social
  
  1. Social smile - 2 mo
  2. Stranger anxiety - 6 mo
  3. Separation anxiety - 9 mo
• Verbal/Cognitive
  
  1. Orients to voice - 4 mo
  2. Orients to gesture - 9 mo
  3. Object permanence - 9 mo
  4. Oratory: “Mama”, “Dada” - 12 mo

Question 10

Developmental milestones: social and verbal/cognitive - Toddler

Answer 10

• Social
  
  1. Recreation - parallel play - 12 mo
  2. Rapprochement - 24 mo
  3. Realization of gender identity - 36 mo
• Verbal/cognitive
  
  1. Words - 200 by age 2, 2 word sentences - 24 mo

Question 11

Developmental milestones - motor - preschool

Answer 11

• Drive yo trike - 3 wheels, 3 years - 36 mo
• Drawing - stick figure - 4 yr
• Dexterity - hop on one foot - 4 yr, zippers - 5 yr

Question 12

Developmental milestones - social and verbal/cognitive - preschool

Answer 12

• Social
  
  1. Freedom - can spend most of day away - 3 yr
  2. Friends (imaginary) - 4 yr
• Verbal/cognitive
  
  1. Language - 1000 words (3 zeros) by 3 yr
  2. Legends - detailed stories - 4 yr

Question 13

Where is the site of action of sildenafil et al?

Answer 13

phosphodiesterase 5 in corpora cavernosa of smooth muscle of venous plexus of penis.

Question 14

Which cells maintain high testosterone concentrations in the epidydimis? How?

Answer 14

Sertoli cells produce androgen-binding protein. Similar structure to sex-hormone binding globulin.

Question 15

quadruple screen values for Down’s, Edward’s, Patau

Answer 15

• Down’s
  
  • Low AFP, low estriol, elevated bHCG, elevated inhibin-A, low PAPP-A
• Edwards
  
  • Low AFP, low estriol, low bHCG, normal inhibin-A
• Patau
  
  • low bHCG, low PAPP-A