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PROLOG > REI > Flashcards

REI Flashcards

1
Q

Tamoxfen is approved for women __yrs and older for prevention of estrogen receptor + breast cancer and reduces the risk by nearly __%

What is the most common endometrial abnormality caused by Tamoxifen?

A

35 yo, 50%

Polyp (8-36%), endometrial hyperplasia (1-20%)

Risk of endometrial cancer is 1.3-7.5x that of untreated women

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2
Q 
Normal semen parameters for 
Volume 
Concentration 
Progressive motility 
Total motility
Normal morphology
A 
Volume 1.5 mL 
Concentration 15 million/mL
Progressive motility 32%
Total motility 40%
Normal morphology 4%
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3
Q

Spwrmatogenesis takes __days

A

60-80

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4
Q

How do you test for obstructive causes of a azoospermia?

A

Fructose is absent in cases of obstructive azzospermia

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5
Q

How to treat ovarian hyper stimulation:

A

Mostly supportive.

Cabergoline (dopamine agonist) reverses the VEGF-2 dependent vascular permeability

Replace electrolytes

Do not proceed with IVF because pregnancy will worsen condition

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6
Q

Secondary amenorrhea is defined as:

A

Lack of 3 consecutive periods or cessation of bleeding for 6 months

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7
Q

What is the only contraceptive that has been shown to decrease the risk of ovarian cancer?

A

OCPs, decreases risk of ovarian cancer by 46-50% even in BRCA1 carriers

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8
Q

Women with eating disorders or low relative caloric intake demonstrate increased OR decreased levels of the following:

Leptin 
Ghrelin
CRL 
GnRH
Cortisol
NPY (neuropeptide y)
A 
Leptin -  decreased 
Ghrelin- increased 
CRL -increased
GnRH- decreased 
Cortisol- increased
NPY (neuropeptide y) increased
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9
Q

First line method of fertility treatment for couple with unexplained infertility?

A

Ovulation induction + IUI - increased fecundity from 1-4% to ~9.5% (normal is 20-25% per cycle)

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10
Q

The finding most consistent with early menopausal transition is__?

A

Persistently irregular cycles

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11
Q

Best method for preserving fertility for women undergoing cancer treatments rendering them sterile.

A

Embryo banking- its cryopreservation is more successful than oocyte preservation

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12
Q

Endometrial biopsy is warranted in a patient with post menopausal bleeding when the endometrial thickness is less than or equal to ___mm.

A

4

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13
Q

Approximately ___% of postmenopausal women started on combined HT will have bleeding in the first 4-6 month

A

40

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14
Q

What phase of the menstrual cycle contributes most to cycle length?

A

Follicular (luteal phase is almost always 14d)

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15
Q

Screening for BRCA individuals

A

Breast: semiannual mammo and MRI starting at age 25

Ovarian: (controversial) CA125 and TVUS starting at 30yo or 5-10yrs earlier than earliest age of family member ca

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16
Q

Most important factor for pregnancy success rate after tubal reanastomosis is ___?

A

Age of patient (followed by length of tube, site or type of tubal, prior fertility)

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17
Q

Managaemt decision tree for macroadenoma (>10mm)

A

Is it prolactin secreting? — if yes then dopamine agonists before considering surgery

If no then surgery

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18
Q

Tanner stage 4 breasts with primar amenorrhea, no pubic or axillary hair…dx?

A

Androgen insensitivity

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19
Q

Which SSRI has least interaction with tamoxifen levels when being used to treat sx hot flashes?

A

Venlafaxine

20
Q

What personality is particularly resistant to CBT?

A

Borderline

21
Q

Postpartum thyroiditis occurs within ___ of pregnancy.

Women with ____ (4) conditions should have their TSH checked at 3 and 6 months. Because they are at increased risk of postpartum thyroiditis.

Tx involves ___. It typically lasts ___months.

A

1 year

Thyroid antibody positive, graves, chronic viral hepatitis

Observation (low dose levothyroxine if sx during hypothyroid phase)

4-6 months

22
Q

SSRI are effective in treating _ eating disorder but not __ eating disorder.

A

Bulimia nerviosa but not anorexia

23
Q

What is the relative vs absolute risk of COC users vs non-OC users for VTE?

A

RR is 2.0 for OC users

AR is 5-10 per 10k vs 10-20 VTE events per 10k for OC users

24
Q

CAH are autosomal ___ disorders.

Controversial tx with dexamethasone should occur before ___ weeks to potentially prevent genital virtualization of a female fetus.

A

Recessive

9 weeks

25
Q

McCube Albright syndrome characterized by 2/3 of the following:

Workup

Management

A

Cutaneous pigmentations which stops at midline, polyostotic fibrous dysplasia, multiple endocrine abnormalities.

Peripheral precocious puberty- workup includes gonadotropin levels, sex steroid levels, tsh, pelvic US, and x-ray of dominant hand to evaluate bone age.

Aromatase inhibitors

26
Q

Evaluation for premature adrenarche includes:

A

DHEAS, FSH, LH, testosterone, TSH, morning 17 OHP.

Patients with premature adrenarche are more likely to develop PCOS

27
Q

The most common complication of UAE for sx fibroids:

Less common complications, but they exist:

A

Post-embolization syndrome: pelvic pain, cramping, N/V, fatigue, myalgia, leukocytosis for 48 hrs, improving in the first week

Infection, hemorrhage, chronic malodorous vaginals discharge, vaginal passage of fibroids, ovarian insufficiency

28
Q

What tissue is best to use for pre-implantation genetic testing?

A

Trophectoderm biopsy

29
Q

What endometrium would be found in a biopsy of a PCOS patient with an ovulation for 6 months?

A

Disordered proliferation endometrium

Secretory would indicate they ovulated and there is progesterone effect

30
Q

What test helps to differentiate thyrotoxicosis when elevated thyroid levels are identified.

A

Radioiodine uptake (if not pregnant or breastfeeding)

T3/t4 ration can be used but less accurate ( >20 graves and toxic multinodular, <20 painless of postpartum thyroiditis)

31
Q

Best imaging modality for suspected mullerian anomalies with contraindication to MRI?

(MRI would be considered the optimal imaging)

A

3D US

32
Q

Best test for no -classic CAH

DDx for androgen excess- no classic CAH, PCOS, androgen secreting tumor

A

Morning follicular serum 17alpha-OHP > 200

Confirmatory testing with ACTH stimulation test- 60 min 17-OHP level will be 1500 or greater

33
Q

Most common tumor that causes central precocious puberty

A

Hypothalamic hamartoma

34
Q

Most appropriate treatment for idiopathic central precocious puberty

A

GnRH agonist

35
Q

What is advanced bone age

A

Greater than 2 yrs and predicted Height of less than 1.5m OR 2 standard deviations below target height

36
Q

How to differentiate central vs peripheral

A

High estradiol and low gonadotropin level = suggests peripheral

High gonadotropin level suggests central

37
Q

What percentage of women with POI will spontaneously conceive?

A

5-10%

38
Q

Fragile x full expansion:

How many repeats can cause POI?

A

Full expansion: 200 CGG repeats

It can be as little as 55-200 CGG repeats that cause POI

39
Q

Why do OCs work to decrease acne?

What progestins are best to use to treat acne with COCs?

A

Decrease free androgens by increasing SHBG and decrease ovarian androgen production

Third generation progestins- deaogestrel, norgestimate. Drospirenone is similar and also increases SHBG to a greater extent.

40
Q

How to manage Swyer’s syndrome after gonadectomy?

A

Graduated increase in estrogen, progestin after first bleed or after 2 years if no bleeding.

Pregnancy is possible with donor egg

41
Q

Management of elevated prolactin in an amenorrhea female who does not desire pregnancy and without bothersome galactorrhea

A

Obtain MRI and put on OCPS for birth control and prevention of osteoporosis

If micro adenina- repeat prl and MRI in 1 yr
If macroadenoma- (10mm or greater)obtain further hormone testing and neurosurgery consult

Dopamine agonists therapy if does not desire OCPs, no -tumor related hyperprolactinemia, micro adenina or bothersome galactorrhea

42
Q

Most common gestational hyperandrogenic causes:

A

Luteomas of pregnancy and hyperreactio luteinalis

Both are benign, both typically regress after pregnancy

43
Q

Main phenotypic difference between androgen insensibility and swyers syndrome?

A

Swyers - no breasts, AIS- breasts! (estrogens converted from testosterone)

No internal female structures/blind ending vaginal pouch in androgen insensivity whereas Swyer’s syndrome has uterus and Fallopian tubes and gysgenic gonads

44
Q

Initial hormone evaluation for secondary amenorrhea

A

FHS, LH, TSH, PRL, and BhCG

45
Q

What is used for ovulation induction for women with functional hypothalamic amenorrhea?

A

Gonadotropin; clomiphene will not work without a functioning HPO axis

46
Q

Fertile window is __.
Follicular rupture occurs __hrs after LH surge.
Fertilízale life of an oocyte is __hr.
Sperm last for __ days.

A

Up to 24hrs after LH surge to 24hrs over ovulation (day of ovulation)

36-40hrs after the onset of LH surge

12-24hrs

5 days

47
Q

Initial lab testing for hirsutism?

A

DHEAS, free and total testosterone, morning follicular phase 17OHP, TSH, and Prl

PROLOG (5 decks)

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