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USMLE Step 1 Systems > Repro > Flashcards

Repro Flashcards

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USMLE® Step 1 flashcards
1
Q

Infant born to IVDU who develops oral thrush, lymphopenia, interstitial pneumonia in 1st year of life - what dx? what tx could have prevented this?

A

HIV: 3 part regime of zidovudine:

  1. mom 14 wks and after
  2. during delivery
  3. infant x first 6 wks of life
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2
Q

Malformation vs. Disruption vs. Sequence

A

Malformation: primary defect in development. ex: holoprosencephaly

Disruption: secondary breakdown of previously nl tissue. ex: Amniotic band syndrome. Amnion ruptures during fetal development - amniotic bands that may compress fetal limbs

Sequence: resulting from a single defect. Potter sequence.

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3
Q

Imperforate Anus is associated with what other congenital abnormalities?

A

Urogenitary tract abnormalities! (ex: meconium that doesn’t pass may pass into urethra or vagina thru fistula)

Note: VACTERL is much less common than the above.

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4
Q

Comedocarcinoma?

A

Form of DCIS with solid sheets of pleomorphic high grade cells with central necrosis.

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5
Q

Course of Ureter

A

Under gonadal vessels
Above the Ext/Common Iliac, Anterolateral to Int Iliac
Under the uterine artery, medial to ovarian vessels

Q1804

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6
Q

Prenatal intraventricular hemorrhage occurs due to bleeding from?

A

Germinal Matrix

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7
Q

When is hCG detectable in blood vs. urine after fertilization?

A

1 wk = blood (after implantation)

2 wks = urine.

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8
Q

What should a 3 yr old be able to do?

A

Gross - alternating feet stairs, tricycle
Fine - copies a circle, uses utensils
Speech - 3 word sentences, 75% intelligible
Social - knows age/gender, parallel play, imaginative play (not yet cooperative)

Q1781

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9
Q

What should patients be aware of after a vasectomy?

A

Viable sperm may still be present proximal to the ligation. About 20% of individuals still have viable sperm in ejaculate 3 months after the procedure.

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10
Q

What condition can cause absence of vas deferens?

A

Cystic Fibrosis!

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11
Q

What condition presents with maternal virilization?

A

Aromatase deficiency.

Other sx:
female 46 XX masculinization
increased levels of testosterone, androstenedione

(maternal virilization bc androgen can cross the placenta. normally placenta has aromatase)

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12
Q

Anti-Rh(D) immunoglobulin is what type of Ig?

A

IgG

Does not cause transplacental fetal hemolysis bc the amount given is much less than what is made in an immune reaction.

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13
Q

Baby of Mom with diabetes will have transient ______ after birth.

A

Hypoglycemia. Baby had compensatory insulin hypersecretion due to inc. glucose load from mom.

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14
Q

Mifepristone (RU-486) Mech?

A

Anti-Progestin

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15
Q

Labs values associated with Klinefelter’s?

A

47XXY

Increased LH and FSH:
=> Dysgenesis of seminiferous tubules -> dec. inhibin -> inc. FSH
=> Abnormal leydig -> dec. testos -> inc. LH -> Inc. estrogen

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16
Q

Symptoms of caudal regression and what its associated with?

A

Caudal Regression: agenesis of the sacrum and sometimes, lumbar spine.

  • flaccid paralysis, absent reflexes
  • urinary incontinence

Associated poorly controlled maternal diabetes!

17
Q

Mom comes for visit at 14 wks gestation. Twins, a male and female. What type of twin placentation is most likely?

A

Dichorionic Diamniotic.

DIZYGOTIC since two diff sexes.

18
Q

What can arise about 10 years after radical masectomy?

A

Lymphangiosarcoma - neoplasm of the endothelial cells of lymphatic channels

19
Q

Endometritis

A

Infection of Endometrium after Delivery usually

- fever, leukocytosis, tender uterus, foul smelling discharge

20
Q

How do seminiferous tubules and epididymis maintain high levels of testosterone?

A

Sertoli cells secrete ABP - androgen binding protein.

21
Q

Hydrops Fetalis + hemoglobinopathy =

A

Alpha thalassemia.

22
Q

Where is the prostate located on imaging?

A

Just posterior to the pubic symphysis.

23
Q

Epithelium of diff parts of the female reproductive tract?

A 
Vagina = Strat squamous, non-keratinized
Ectocervix = Strat squamous, non-keratinized

Endocervix = Simple columnar
Uterus = Simple columnar, long tubular glands
Fallopian Tube = Simple columnar, with ciliated cells and few peg secretory cells

Ovary = simple cuboidal*

24
Q

Cryptorchidism - clinical presentation?

A

Bc of the increased temp, Seminiferous tubules become atrophic and hyalinized:

  • low sperm count
  • decreased inhibin secretion from Sertoli cells.

Leydig cells are okay - testos and secondary sex are nl.

Should be corrected early in life to prevent damage to seminiferous tubules and prevent testicular cancer.

25
Q

Congenital Torticollis - presentation, cause, tx?

A

Sx: Palpable mass/contraction of SCM, Infant prefers to face the other direction

Cause: Intrauterine malposition - fetal macrosomnia, oligohydramnios

Tx: Conservative Therapy, Stretching.

26
Q

Candida vulvovaginitis - what predisposes?

A 
Antibiotic Use
OCP Use 
Systemic Corticosteroids
uncontrolled Diabetes
immunosuppression
27
Q

Pt with malignant scrotal neoplasm + hyperthyroidism. What marker is likely elevated?

A

hCG - structurally similar to TSH to get hyperthyroid.

28
Q

What condition gives you increased AFP vs. decreased AFP?

A

Increased AFP: NTD, multiple gestation, abd wall abnl

Decreased AFP: Down’s

29
Q

Congenital Hypothyroidism Presentation

A 
Hypotonia 
Poor feeding
Jaundice 
Macroglossia 
Constipation
Umbilical Hernia.
30
Q

PCOS increases risk of what carcinoma? Other features?

A

Endometrial carcinoma

Sx: 
Anovulation, Oligovulation, infertility 
Hyperandrogen (hirsuitism, acne) 
PCOS 
insulin resistance
abnl lipid profile - risk of CAD, athero

Labs:
Inc. LH, Normal FSH, LH:FSH 3:1
Inc Testosterone, Inc Estrogen
Insulin resistance

31
Q

Clomiphene

A

PARTIAL AGONIST at estrogen-R in hypothalamus - inhibit normal feedback inhibition - INCREASE LH AND FSH - stimulate ovulation

32
Q

Tamoxifen

A

Used for ER+ breast cancer

Breast: Antagonist

Uterus: Agonist - risk of endometrial cancer
Bone: Agonist

33
Q

Raloxifene

A

Used for osteoporosis
Bone: Agonist

Uterus: Antagonist
Breast: Antagonist

34
Q

Mifepristone

A

Prosgestin Inhibitor

Termination of Pregnancy
Often administered with Prostaglandin.

35
Q

Terbutaline

A

Beta-2 agonist - relaxes the uterus

Tocolysis.

36
Q

Danazol

A

Partial agonist at androgen-R

Used for endometriosis and hereditary angioedema
Toxicity: androgenic effects

37
Q

Antiandrogen Drugs

A

Finasteride: 5alpha reductase inhibitor - for BPH, male patterned baldness

Flutamide: competitive antagonist at testo-R - for Prostate adenocarcinoma

Ketoconazole- inhibits desmolase

Spironolactine - inhibits steroid binding, desmolase, 17a-hydroxylase

38
Q

Ovarian carcinoma

A

Sx: vague abd distension, poor appetite, nausea, abd distension, free fluid in perioneum, pleural effusion

+ Adnexal mass

Measure progression: CA125
Risk Factors: anything that increased uninterrupted ovulatory cycles..

39
Q

What are the following material in amniotic fluid measured for?

Surfactant
AFP
Acetylcholinesterase

A

Surfactant = fetal lung maturity

  • measured as L:S ratio
  • surfactant:albumin ratio
  • slide agglutination for phosphatidylglycerol
  • foam stability index: add EtOH and see at what conc stable ring forms

AFP: high = NTD; low = Down’s

Acetylcholinesterase = NTD

USMLE Step 1 Systems (11 decks)

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