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STEP I 2014 > Reproductive > Flashcards

Reproductive Flashcards

1
Q

patter of hormones during gestation

  • 17-OH protgesterone/hCG
  • progesterone/hPL
  • cortisol
A
  • rises during 1st tri and then falls (17-OH declines after destruction of corpus lutem, and hCG declines after placenta no longer needs corpus lutem)
  • increase steadily throughout pregancy (P-maintain uterine lining and hPL increases with fetal mass)
  • increases steadily starting around wk 28-initiates labor and fetal lung maturation
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2
Q

pts risk of breast cancer is increased with sclerosing adenosis with ductal hyperplasisa and not apocrine metaplasia because

A

apocrine metaplasia is benign, common, non-proliferative change and associated with increased breast cancer risk, Sclerosisng adenosis is a type of proliferative fibrocystic dz, if hyperplastic is can lead to invasive breast cancer.

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3
Q

pt taking drug that increases gonadotropins, decreases estradiol and endometrial proliferation blocks aromatase and not estrogen receptors because

A

blocking estrogen receptors would decrease endometrial proliferation. however the lack of negative feedback of estrogen on hypo would lead to increased levels of gonadotropins and estradiol. blocking aromatase would result in decreased estradiol despite increased levels of gonadotropins

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4
Q

what cells express LH receptors during early follicular phase? and which express LH receptors during late follicular development?

A

theca cell and granulosa cell

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5
Q

P450scc

A

side chain cleavage enzyme. first step in ovarian steriodogenesis, converts cholesterol to pregnenolone.

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6
Q

drug used to treat herpes blocks viral DNA polymerase and not viral release from cell because

A

viral release from cell are the action so of neuraminidase inhibitors (-ivir=influenza), whereas drugs that inhibit viral DNA polymerase (-ovir i.e. Acyclovir) are used to treat herpes

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7
Q

describe glands, stroma, and mitotic figures in the different stages of endometrium development

A
  • early proliferative 4-7 days-glands-straight and short, compact stroma, little mitotic activity
  • mid proliferative phase 6-10 days-glands are longer, little stromal edema, numerous mitotic figures
  • later proliferative 11-14, wavy glands, subnuclear vacuoles, prominent mitotic activity,
  • secretory phase- stromal edema
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8
Q

asynchronous secretory endometrium

A

secretory epithelium has mismatch of staging between stroma and glands.

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9
Q

proliferative endometrium wit stromal breakdown

A

cause of bleeding in anovulation

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10
Q

bone metastases type:

breast, prostate, colon, kidney, lung, thyroid,

A
  • both blastic and lytic
  • blastic
  • doesn’t metastasize to bone
  • the rest produce lytic lesions
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11
Q

a young girl with virilization, HTN, hypoK, hyper 17-OH progetersone, and hypoALD has a defect in 11-beta-hydroxylase and not 17-alpha hydroxylase because

A

all CAH mutations lower CTH and would cause low blood pressure. the only reason for HTN is b/c of elevated 11-deoxycorticosterone (11-DOC) seen in 11-beta-hydroxylase. 17-alpha mutation would cause lack of secondary chacteristics in females and pseudo-hermaphroditism in males

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12
Q

PLAP and CD17 are markers for

A

seminoma cell membrane

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13
Q

drug with PE2 and oxytocic activity used to induce cervical softening during labor is dinoprostone not misoprostol because

A

misoprostol has PE1 not PE2. both can be used to ripen cervix

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14
Q

mechanism of cephalasporins

A

like penicillins, inhibit cell wall synthasis by blocking transpeptidaton enzymes. not as susceptible to beta lactams (aka penicillinases.)

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15
Q

young female athlete with irregular menstruation needs a progestin challenge and not clomiphene because

A

progestin challenge will confirm anovulation. anovulation can be treated with C (blocks estrogen mediated negative feedback on hypothlamus)

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16
Q

a pt with 46 chromosomes, a barr body, and ambiguous genitalia has excess production of androgens and not mutation of androgen receptor gene becuase

A

this pt is a female (a Barr body is only found in females). thus the ambiguous genitalia is due to over production of androgens. AID (androgen insensitivity syndrome) results in male (46XY) with external female features.

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17
Q

ground glass nuclei, cowdry type A bodies, and multinucleated giant cells dz and treatment

A

HSV-acyclovir

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18
Q

ampB +fluconazole treats

A

cryptococcus neoformans

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19
Q

hypospadias

A

congenitital displacement of urethral opening onto ventral surface (underside) of penis. can lead to UTIs or infertility

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20
Q

phimosis

A

foreskin cannot be retracted over shaft of penis

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21
Q

preeclampia symptoms before 20wks gestation is most likely, after 6 months

A

hydatidiform mole

twin gestation or anencephaly(causes polyhydramnios)

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22
Q

16 year boy with painless lump in left breast and no fluid discharge, most likely has gynecomastia and not intraductal papilloma because

A

gynecomastia is common in youth and can occur in one or both breast. intraductal papilloma is rare in men and would present with blood nipple discharge

23
Q

major of testosterone is bound to

A

sex-steriod binding globulin and vry little is bound to albumin

24
Q

Cal-Exner bodies

A

granulosa cell tumors, uniform cuboidal cells resembling structures reminiscent of ovarian follicle

25
Q

bicornate uterus

A

abnormal Y shaped uterine cavity- can cause spontaneous abortions in 2nd trimester

26
Q

testicular arteries originate from. penis is supplied by

A

aorta, internal pudenal artery (from internal iliac artery)

27
Q

location of hernias

A

all are lateral to lateral wall of rectus muscle
direct-within inguinal triangle, medial to i. epigastric art and vein, superior to inguinal canal.
indirect-lateral to epigastrics, through both deep and superficial inguinal rings (surrounded by all 3 layers of fascia)
femoral-through superficial inguinal ring, posterior to inguinal ligament

28
Q

initial event of preeclampsia

A

placental ischemia-trigger release of thromboplastic substances, increases renin synthesis and reduces prostaglandin E levels.

29
Q

epithelial hyperplasia and not ca2+ deposits is associated with an increased risk for breast cancer because

A

calcium deposits are seen in malignant and benign lesions and used mostly for diagnostic purposes. where as proliferative changes such as hyperplasia can lead to carcinoma

30
Q

activin vs inulin

A

activate FSH vs inhibit FSH, produced in testes.

31
Q

pt with mental retardation, X chromosomal breakage, and macro-orchidism may also have cardiac abnormalties and not renal because

A

pt has fragile X syndrome- Xtra large testis, ears, and jaw. also associated with mitral valve prolapse and autism. x linked defect affects methylation of FMR1 gene.

32
Q

bleeding in placenta previa vs placenta abrupton

A

previa is painless and abruption is painful bleeding

33
Q

hematosalpinx def and causes

A

bleeding into fallppian tubes-ectopic preg or transverse vaginal septum (obstruction of blood flow)

34
Q

test results for Downs

Edwards and Patau syndromes

A

downs-increased nuchal transluency, decreased Papp-a and increased free beta-hCG
edwards- low PAPP and low beta-hCG
patau-low free beta-hcg, low papp-a, increased nuchal translucency

35
Q

most important factor for pathogenesis in N gonorrhae is pili and not IgA protease because

A

although N. gonorrhae produces IgA protease to allow for mucosal colonization pili are what allow it to adhere to membrane, inhibit phagocytosis, and undergo antigenic variation

36
Q

violin string adhesions of peritoneum to liver

A

fitz-hugh-curtis syndrome-infection of gillson’s capsule (liver capsule) due to severe PID

37
Q

processus vaginalis becomes

A

tunica vaginalis, partial closure results in hydrocele in children

38
Q

increased number of columnar cells with preservation of BM

moderately differentiated cells with striated pattern

A

endometrial hyperplasia

rhabdomyomasw

39
Q

hyperplasia to invasive adenocarcinoma

A

simple hyperplasia-dilated and irregular glands rare risk
complex hyperplasia w/o atypia- irregular glands and mitotic figures 5% risk
complex hyperplasia with atypia- glands, mitotic cells, and nuclear atypia. 25% risk

40
Q

male pt with ambigous genetial, lipid laden adrenals, and decreased levels of all steroids (C21, C17, and C18), with no response to ACTH or hCG has Steroidogenic acute regulatory protein (StAR) defiecncy and not 21-alpha hydroxylase def. because

A

21-alpha hydroxylase wouldn’t lead to a decrease in all steroid production in fact it would increase androgen production. StAR is needed to transport cholesterol from outer to inner mintochondral, adrenal, and gonadal membranes. manifest at young age-congenital lipoid adrenal hyperplasia

41
Q

man with thickened, whitish plaque with slightly ulcerated, crusted surface. biposy shows dysplatic epithelial cells, mitoses, disorder epithelium and intact BM has SCC in situ and not condyloma acuminatum because

A

lesion is Bowen Disease- vs condyloma which is usually a papillary lesion.
other types of SCC in situs lesions are BBQ
bowen, bowenoid(mutiple reddish brown pauplar lesions), and queyrat (shnny red papules)

42
Q

white skin plaques on or near genitals with inflammatory infiltrate at dermal-epidermal junction and thinned epidermis

A

lichen sclerosis

43
Q

reduced inhibin levels in young woman

A

premature menopause

44
Q

whorled pattern with well demarcated borders

A

leiomyoma (fibroid)

45
Q

pregancy mother presenting with symptoms of DM has increased hGH and not decreased hGH because

A

human growth hormone is released by placenta and acts like growth hormone, stimulating insulin-like growth factor (IGF-1) to increase glucose and amino acids for baby, also hGH has anti-insulin effects and can cause DM

46
Q

cell cycle phase before ovulation

A

diplotene stage of prophase 1 of 1st meiotic division

47
Q

posterior fornix is in contact with

A

retrouterine space-pouch of Douglas

48
Q

middle layer of urogentital diaphragm, containing sphincter urethrae muscle
below and lateral to pelvic diaphrage
between bladder and rectum in males
spce in female pelvis between bladder and uterus

A

deep perineal pouch, ischioanal space,rectovesical space, vesicoutrine space

49
Q

multi giant nulceated cells originate from, rxn in breast is

A

histocytes, fat necrosis

50
Q

RB suppression is associated with

A

CIN, retinoblastoma, osteosarcoma, colon, and lun

51
Q

structure drainage:

  • superficial inguinal nodes
  • testes
  • deep inguinal nodes and part of uterus
  • bladder, internal genital glands, parts of uterus and cervix
  • buttocks, loever limbs, anterior abdomin wall, perineum
A
  • deep inguinal nodes
  • para-aorta
  • external iliac nodes
  • internal iliac nodss
  • superficial ingunial nodes
52
Q

palpate the what in order to perform a pudendal nerve block

A

ischial spine-connects greater and lesser sciatic foramens

53
Q

male pt with normal internal genital and femized external genetials has 5alpha reductase deficency and not complete androgen resistance because

A

complete androgen resistance results in no internal genitals. 5alphaR is needed to convert T to DHT which is needed for 2ndary virilization

54
Q

quetion 33.34

A

answers

STEP I 2014 (14 decks)

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