Repro

Question 1

Direct vs Indirect inguinal hernias

• what PE finding will help you distinguish between the two
• relation to inferior epigastric artery
• layers

Answer 1

Both: pass through the superficial inguinal ring
-both produce a cough in the groin when a person coughs

Indirect: pass through deep inguinal ring too (lateral to inferior epigastric artery)
-covered by all 3 layers of spermatic fascia

Direct: does not pass through deep inguinal ring (medial to inferior epigastric artery)
-covered by only the external spermatic fascia

PE: have pt cough a 2nd time while compressing the deep inguinal ring
-if it prevents the hernia from descending -> must pass through deep inguinal ring -> indirect hernia

Question 2

Failure of what to close causes an indirect inguinal hernia

Answer 2

Processes vaginalis -> persistent connection between abdominal cavity and inguinal canal
-associated with hydroceles

Question 3

When do hCG levels decrease and why

Answer 3

2nd trimester -> placental progesterone can maintain pregnancy by then

Question 4

What causes insulin resistance in pregnant mothers w/ no history of diabetes

Answer 4

Placental growth hormone

• has anti-insulin effects
• aids in placental maturation

Question 5

What hormone is in charge of

• male external genitalia
• male internal genitalia
• female external genitalia
• female internal genitalia

Answer 5

Male

• external genitalia: Dihydrotestosterone via leydig cells
• internal genitalia: testosterone via wolffian duct

Female

• external genitalia: estriadiol via ovaries
• internal genitalia: paramesonephric duct

Question 6

What drug inhibits 5alpha-reductase and can lead to abnml male external genitalia if used during pregnancy

Answer 6

Finasteride

Question 7

What results in a a congenital hydrocele

Answer 7

Failure of obliteration of processes vaginalis

Question 8

14 year old girl has never menstruated before

• 46 XY karyotype
• labs: elevated testosterone and LH
• PE: vagina but no uterus is palpable

Defect?

Answer 8

Androgen insensitivity syndrome

• testosterone is produced but cannot bind to receptor
• internal genitalia and external genitalia need Testosterone and DHT to be produced -> ambiguous genitalia
• famle internal genitalia is not present due to nml AMG

Question 9

When will the startle reflex (making aloud noise will startle the baby and cause them to extended and abduct their arms w/ fingers spread) disappear

1-2 months
3-6 months
8-10 months

Answer 9

3- 6 months

Question 10

What do these become

• ureteric bud
• allantois
• mesonephric duct

Answer 10

Ureteric bud: induces development of metanephros -> kidney

Allantois: urinary bladder (urachus -> median umbilical ligament)

Mesonephric duct: internal male genitalia

Question 11

What hormone stimulates release of testosterone from leydig cells

Answer 11

LH