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1
Q

What ligament carries the uterine blood supply?

Ovarian blood vessels?

A

Cardinal ligament

Suspensory ligament of the ovary

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2
Q

How would a radical prostatectomy cause erectile dysfunction?

A

Cavernous nerves carrying parasympathetics to the penis travel near the prostate and can be damaged during removal

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3
Q

Female equivalent of bulbourethral glands (after prostate)

A

Vestibular (bartholin) glands (dorsal vestibule)

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4
Q

Female equivalent of prostate gland

A

Paraurethra (skene) glands

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5
Q

What does the gubernaculum form in the female?

A

Ovarian ligament (ovary-uterus) + round ligament of the uterus (uterus-labia majora)

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6
Q

What reproductive structures would form if Sertoli cell development was disrupted?

A

Both male and female internal genitalia
No MIF = paramesonephros never regress
Leydig cells still make testosterone = mesonephros develop

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7
Q

Why can obese males become testosterone deficient?

A

More adipocytes = increased amortize activity = depletes normal testosterone production by converting it to estrogen

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8
Q

How would exogenous testosterone increase risk for cardiovascular disease?

A

Increases LDL and decreases HDL

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9
Q

Clinical use for finasteride?

Flutamide?

A

Finasteride (5a-reductase inhibitor) - DPH, male-patterned baldness
Flutamide (testosterone R inhibitor) - prostate CA

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10
Q 
What causes:
Female pseudohermaphrodite (XX + ambiguus genitalia)
Male pseudohermaphrodite (XY + ambiguus genitalia)
A 
Female = congenital adrenal hyperplasia
Male = androgen insensitivity syndrome
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11
Q

Normal female external genitalia + no internal genitalia + bilateral lumps in labia majora

A

Androgen insensitivity syndrome - labs will show increased LH and testosterone
External = no DHT, default female
Internal = Sertoli cells produce MIF to cause paramesonephros to regress, but testosterone cannot maintain mesonephros development
Testes in labia majora = SRY gene from Y chr comes before testosterona/DHT to induce testis formation

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12
Q

Ambiguus genitalia until puberty

A

5a-reductase deficiency - labs will show normal testosterone and LH
No DHT = default female external genitalia
Testosterone increases enough during puberty to cause external genitalia to masculinize

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13
Q

Primary amenorrhea + anosmia

A

Kallmann syndrome - impaired migration of cells that secrete GnRH and that form the olfactory bulb

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14
Q

Fried egg cells

A

Testicular seminoma, oligodendrogliomas, and HPV koilocytes

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15
Q

Scrotal pain that improves when lifted

Scrotal pain that does not improve when lifted

A

Epidydimitis

Testicular torsion

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16
Q

Schiller-Ducal bodies + elevated AFP

A

Yolk sac tumor

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17
Q

Painful testicular lump + elevated hCG

A

Embryonal tumor

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18
Q

Multinucleate giant cells + elevated hCG

A

ChorioCA (syncitiotrophoblasts)

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19
Q

Elevated hCG and AFP

A

Teratoma

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20
Q

Eosinophilic rod-shaped inclusions (Reinke crystals) + gynecomastia

A

Leydig cell tumor - secretes testosterone (visualization in females) that is converted peripherally to estrogen

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21
Q

Testicular lump + gynecomastia (without unique histology findings)

A

Stroll cell tumor - secretes estrogen

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22
Q

3 indications for PDE5 inhibitors

A

Erectile dysfunction, raynaud syndrome, and primary pulmonary HTN

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23
Q

3 side effects of PDE5 inhibitors

Why can they not be taken with nitrates?

A

Headache (vasodilation), dyspepsia, blue-green color vision loss (cross-over with retinal PDE, “Little blue pill”)
Life threatening HoTN

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24
Q

What is Bowen’s disease, erythroplasia of Queyrat, and Bowenoid papulosis? Which can progress to SCC?

A

Bowen disease = leukoplakia on pencil shaft
Erythroplasia of Queyrat = erythroplakia on glans
Bowenoid papulosis = red papules on penis of younger men
Only Bowen and Queyrat progress to SCC

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25
Q

Why is the mechanism for Tamsulosin unique?

A

Specific a-1A/D blocker (specific to the prostate) = BPH

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26
Q

What stage of meiosis are eggs arrested in before ovulation?

A

Prophase 1 (condensed chr)

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27
Q

What stage of meiosis are eggs arrested in after ovulation?

A

Metaphase 2 (chr aligned on metaphase plate)

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28
Q

How many days after ovulation can fertilization occur? When does implantation occur?

A

Fertilization - within 1 day

Implantation - 6 days after ovulation

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29
Q

How does suckling affect hormones of lactation?

A

Increases prolactin (milk production, suppress ovulation) and oxytocin (milk let down)

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30
Q

What must be supplemented to infants that are exclusively breast fed?

A

Vitamin D

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31
Q

What is the order of Tanner stage development for girls?

A

Breast bugs - pubic hair - menarche

32
Q

Which birth control method can decrease bone mineral density?

A

Depo-provera shots (progestin-only)

33
Q

Vulvar pruritis + smooth white plaques + thin epidermis

A

Lichen sclerosis - increases risk for SCC

34
Q

What is the main risk factor for vaginal adenoCA?

A

DES exposure in utero (retained columnar cells in vaginal mucosa) - also causes T-shaped uterus

35
Q

Grape-like clusters in the vagina of a young girl

What is the histological marker?

A

Sarcoma botryoides

Desmin + (rhabdomyosarcoma, has cross-striations)

36
Q

How do E6 and E7 protein expression in HPV cause cancer?

A

E6 degrades p53, E7 inactivates Rb

37
Q

What is the mechanism of Danazol?

A

Androgen R PA

38
Q

What are the 2 indications for Danazol?

A

Endometriosis (inhibits FSH/LH to suppress cycles) and hereditary angioedema (stimulates C1 esterase inhibitor synthesis)

39
Q

What are the 3 most common gynecological tumors?

A

Endometrial (best prognosis) > ovarial (worst prognosis) > cervical

40
Q

What is the mechanism of Leuprolide?

What is the mechanism of Clomiphene?

A

Leuprolide - GnRH analog (continuous antagonist, pulsitile agonist)
Clomiphene - SERM estrogen antagonist in the hypothalamus (only works as an agonist)
= both are used to stimulate ovulation, but Leuprolide can also be used to suppress cycles (leiomyomas, endometriosis)

41
Q

Enlarged tender uterus

Enlarged non-tender uterus

A

Tender - adenomyosis

Non-tender - leiomyoma

42
Q

What type of estrogen is increased in PCOS and why? What does this cause?

A

Estrone - elevated androstenedione is converted by peripheral aromitase into estrone
Chronic estrone elevation suppresses follicular development

43
Q

What is the primary cause of PCOS?

A

Hypothalamic/pituitary dysfunction causing more LH to be secrete than FSH

44
Q

What is the 1 non-reproductive side effect of clomiphene?

A

Visual disturbances (retinal toxicity)

45
Q

Ovarian tumor is associated with simultaneous primary endometrial CA

A

Endometrioma (benign germinal epithelial tumor)

46
Q

Brennor tumor

A

Benign ovarian tumor of bladdar transitional epithelium

47
Q

Dermoid cyst

A

Benign teratoma

48
Q

Meigs Syndrome

A

Ovarian fibroma + ascites + hydrothorax

49
Q

Ovarian tumor with fallopean-like epithelium

A

Serious cystadenoma/cystadenoCA (benign germinal epithelial tumor)

50
Q

Ovarian tumor associated with psammoma bodies

A

Serous cystadenoCA

51
Q

Ovarian tumor that causes Pseudomyxoma peritonei (mucus ascites)

A

Mucinous cystadenoCA

52
Q

Primary tissue found in immature teratoma

A

Immature neuroectoderm

53
Q

Ovarian tumor with fried egg cells

A

Dysgerminoma

54
Q

Ovarian tumor markers hCG and LDH
AFP
hCG

A

Dysgerminoma
Yolk-sac tumor
ChorioCA

55
Q

Ovarian tumor with call-exner bodies (primordial follicles)

A

Granulosa cell tumor - normally outlines follicles, tumor produces so many cell they form follicles without the oocyte in the middle

56
Q

What 3 ovarian tumors are most commonly bilateral?

A

Serous cystademona, endometrioma, and teratomas

57
Q

Krukenburg tumor

A

GI tumor (typically gastric) that metastasizes to the ovaries - signet cell adenoCA (mucin-secreting)

58
Q

Mole without maternal DNA and higher risk for chorioCA

A

Complete mole

59
Q

Antihypertensives safe in pregnancy

“Hypertensive Mothers Love Nifedipine”

A

Hydralazine, a-methyldopa (a2 agonist), labetalol, and nifedipine

60
Q

What is given during pre-eclampsia to prevent seizures

A

Mg Sulfate

61
Q

HELLP syndrome (a type of pre-eclampsia)

A

Hemolysis + Elevated Liver enzymes + Low Platelets

Thrombosis in liver = platelet consumption, RBC shearing, and liver ischemia (elevated LFTs)

62
Q

What are 2 fetal malformations associated with pre gestational DM?

A

Transposition of the great vessels and caudal regression syndrome

63
Q

Bleeding in the 3rd trimester:
Painful
Nonpainful

A

Painful - placental abruption (retained blood irritates the uterus)
Nonpainful - placenta previa (bleeding immediately out the cervix)

64
Q

What are 2 risk factors for ectopic pregnancy that are unrelated to fallopian tube scarring?

A

Smoking (decreases epithelial ciliary motility) and fertilization when IUD is placed

65
Q

What drugs cause gynecomastia?

“Some Drugs Cause Awesome Knockers”

A

Spironolactone, digoxin, cimetidine, alcohol (chronic), ketoconazole

66
Q

Breast stream hyperplasia + blue dome cysts + fluctuates with cycle

A

Fibrocystic change

67
Q

Breast increased number of glands + intraductal fibrosis + calcification

A

Sclerosing adenosis

68
Q

Breast scar with irregular edges, looks like fat necrosis

A

Radial scar (complex sclerosing)

69
Q

Mobile breast mass with sharp edges in a patient under 25, changes with hormones

A

Fibroadenoma - benign

70
Q

Straw colored/bloody nipple discharge

A

Intraductal papilloma - benign tumor within the ducts just beneath the areola

71
Q

Large breast mass with leaf-like projections on histology

A

Phyllodes tumor - benign

72
Q

Intraductal caseous necrosis with central calcification

A

DCIS - comedoCA

73
Q

Eczematous rash or ulceration of the nipple

A

Paget’s disease of the breast (DCIS that migrates out the nipple)

74
Q

Signet ring cells that are ER/PR +

A

LCIS or invasive lobular CA

75
Q

What form of breast cancer arises from inactivation of E cadherin

A

Invasive lobular CA

76
Q

Pt diagnosed with molar pregnancy, what is most likely see in the ovary?

A

Theca-lutein cyst - stimulated by high hCG

USMLE (12 decks)

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