Reproductive System - UWorld

Question 1

What takes over the role of estrogen and progesterone secretion after the corpus luteum regresses around week 10?

Answer 1

Estrogen - fetal adrenal gland

Progesterone - placenta

Question 2

Hormones involved in the pathogenesis of PCOS

Answer 2

High insulin -> high LH:FSH (>3) -> high androgens -> hirsutism and anovulation

Question 3

What hormones result in involution of the paramesonephric (Mullerian) ducts, development of the mesonephric (Wolffian ducts) and male external genitalia?

Answer 3

MIH = paramesonephric duct involution
Testosterone = Wolffian duct formation (seminal vesicles, epididymus, ejaculatory duct and ductus deferens)
DHT = development of external genitalia

Question 4

Etiologies of polyhydramnios

Answer 4

GI tract obstruction
Anencephaly
High fetal cardiac output -> increased urination

Question 5

Immunochemistry in complete vs. incomplete molar pregnancy

Answer 5

Complete = p57-negative
Incomplete = p57-positive

Question 6

Mifepristone mechanism of action

Answer 6

Anti-progesterone drug that causes necrosis and sloughing of the decidual layer

Question 7

Immigrant mom has joint pains and a rash on her neck that spread to her extremities while pregnant. Exam reveals posterior auricular and sub occipital lymphadenopathy. What conditions might the fetus have at birth?

Answer 7

She has rubella and likely did not receive the live-attenuated MMR vaccine prior to pregnancy. Congenital rubella syndrome consists of cataracts, cardiac defects (PDA) and sensorineural deafness.

Question 8

Regions of the male urethra

Answer 8

Posterior urethra: prostatic and membranous segments

Anterior urethra: bulbous and penile segments

Question 9

Ligament that contains the ovarian artery, vein, lymphatics and nerve

Answer 9

Suspensory ligament of the ovary (i.e. tubuloinfundibular ligament)

Question 10

Ligament that contains the uterine artery

Answer 10

Cardinal ligament (i.e. transverse cervical ligament)

Question 11

Degrees of vaginal tearing with birth

Answer 11

1st = through superficial skin + mucosa
2nd = through perineal body
3rd = through external/internal anal sphincter
4th = through rectal mucosa

Question 12

Levator ani muscles

Answer 12

Ileococcygeus and pubococcygeus

Question 13

Hormones that act on the ovary

Answer 13

LH -> theca interna -> progesterone and androgen synthesis

FSH -> granulosa cells -> aromatization of androgen to estradiol

Question 14

Why does hCG work to induce ovulation

Answer 14

It has a similar alpha-subunit as LH, FSH and TSH. The similarity to LH induces follicle rupture from the ovary.

Question 15

Vaginitis with normal pH

Answer 15

Candidiasis.

Trichomoniasis and bacterial vaginosis have higher pHs

Question 16

Most common cause of Turner syndrome. Why do they have short stature?

Answer 16

Paternal non-disjunction of the X chromosome during meiosis II, resulting in 45XO phenotype in almost all cells. Patients will have short stature due to loss of SHOX gene, which promotes long bone growth.

Question 17

Differentiating primary ciliary dyskinesia from cystic fibrosis

Answer 17

Primary ciliary dyskinesia may have situs inversus and immotile sperm due to defect in dyenin arm.

CF may have pancreatitis and absent vas deferens

Question 18

Which syphilis tests can you use to track response to anti-treponemal therapy?

Answer 18

RPR and VDRL test for presence of cardiolipin, a byproduct of T. palladium infection. FTA-ABS tests for antibodies against treponemal antigens that remain positive for life.

Question 19

Cancers associated with trisomy 21

Answer 19

AML-M7 and ALL as children

Question 20

Hormone levels in Klinefelter syndrome

Answer 20

Hyalinization and fibrosis of seminiferous tubules -> non-functioning Sertoli cells -> increased FSH

Leydig cell dysfunction -> low testosterone -> increased LH

Question 21

Gonadal arteries originate from…

Answer 21

Aorta, below renal arteries

Question 22

Mayer-Rokitansky-Kuster-Hauser syndrome. Next think to check for when you make this diagnosis?

Answer 22

Blind vaginal pouch originates from urogenital sinus and absent uterus due to Mullerian (paramesonephric) agenesis. The next think you should do is a renal ultrasound because 50% of these patients may have a co-existing renal abnormality like renal agenesis.

Question 23

Post-op patient with scrotal and medial thigh numbness after pelvic surgery

Answer 23

Injury to the genitofemoral nerve, most commonly due to retraction against the nerve as it lies on the psoas muscle

Question 24

Nerve at high risk for injury during Pfannensteil incision C-section.

Answer 24

Iliohypogastric nerve innervates the suprapubic skin and lies near the site of incision

Question 25

Loss of medial thigh sensation and ability to abduct after retroperitoneal lymph node dissection

Answer 25

Obturator nerve injury

Question 26

Definition of primary amenorrhea

Answer 26

No menses or secondary sex characteristics by 13

No menses with secondary sex characteristics by 15

Question 27

Mechanism for gestational hyperglycemia

Answer 27

Increasing levels of hPL secreted by the syncytiotrophoblasts results in increased insulin resistance, increased insulin release, increased maternal proteolysis and lipolysis. GDM occurs when the pancreas cannot secrete enough insulin to keep up with the increased blood glucose levels.

Question 28

Most common type of ovarian germ cell tumor

Answer 28

Mature teratoma

Question 29

Conditions associated with increased and decreased maternal serum AFP

Answer 29

Increased: multiple gestations, open neural tube defects and abdominal wall defects

Decreased: aneuploidy. Trisomy 21 will also have low E2, increased inhibin A and increased beta-hCG

Question 30

How can a translocation cause Down syndrome?

Answer 30

Translocation of both long arms of chromosome 21 to chromosome 14 with a single normal 21 chromosome results in three chromosome 21s.

Question 31

Common presentation of a gonadotrophic pituitary adenoma

Answer 31

Mass effect, the alpha-subunit of FSH and LH are typically inactive

Question 32

Most common cause of an elevated AFP

Answer 32

Dating error

Question 33

How does the date of separation determine the placenta and amnion status in monozygotic twinning

Answer 33

Days 0-4 = di, di
Days 4-8 = monochorionic diamniotic
Days 8-12 = monochorionic, mono amniotic
> 13 days = conjoined

Question 34

Painful genital ulcer with:
A) Gray-yellow exudate, organisms clumped in long parallel strands like a school of fish

B) Multinucleate giant cells and intracytoplasmic inclusions

Painless genital ulcer with:
C) Extensive and progressive lesions with deeply staining gram-negative intracytoplasmic inclusions cysts and granulation tissue

D) Clean erythematous base with thin, delicate, corkscrew organisms on dark field microscopy

E) Small, shallow rapidly healing ulcers with intracytoplasmic inclusion bodies in epithelial cells and leukocytes

Answer 34

A) Chancroid
B) Genital herpes
C) K. inguinale (donoviasis)
D) Syphilis
E) Lymphogranuloma venereum

Question 35

Antibiotic that can cause a disulfiram-like reaction when taken with alcohol

Answer 35

Metronidazole

Question 36

Why might a patient with a germ cell tumor present with paraneoplastic hyperthyroidism?

Answer 36

beta-hCG has the same alpha subunit as TSH, LH and FSH and can bind to TSH receptors and cause symptoms of hyperthyroidism

Question 37

Genes that predispose patients to pheochromocytoma

Answer 37

VHL, RET1 and NF1

Question 38

Treatment of Graves’ ophthalmopathy

Answer 38

High dose steroids to reduce Th1-mediated fibroblast stimulation

Question 39

Lymph node drainage from the testes? Glans and posterior superficial calves? Scrotum?

Answer 39

Testes = para-aortic
Glans and posterior calf = deep inguinal
Scrotum = superficial inguinal

Question 40

Why preserve the prostatic shell in a patient undergoing prostatectomy?

Answer 40

The inferior hypogastric plexus gives off the prostatic parasympathetic nerve plexus in the prostatic fascia. The greater and lesser cavernous nerves exit the prostatic fascia to innervate the corpora cavernosa and are the nerves involved in erection.

Question 41

Invasive mole vs. gestational choriocarcinoma

Answer 41

Invasive mole has diffusely hyper plastic trophoblasts invading the myometrium as chorionic villi
Choriocarcinoma has anaplastic and necrotic trophoblasts invading blood vessels and no chorionic villi