Reproductive- UWORLD

Question 1

119- Q 3. What is rectocele?

Answer 1

posterior vaginal wall prolapse
: may cause constipation as enlarged rectum may trap feces
( uworld has pretty good picture to explain this)

Question 2

119- Q 4. How does untreated PID can cause infertility?

Answer 2

scarring of fallopian tubes

-> ectopic pregnancy or infertility

Question 3

119- Q 11. How to describe endometrial polyp vs. endometrial hyperplasia

Answer 3

• endometrial polyp: OUTGROWTH of endometrial tissue from surface of endometrium
• endometrial hyperplasia: abnormal proliferation of endometrial GLAND compared to stroma

Question 4

119- Q 17. Describe uterine curretage finding in ectopic pregnancy

Answer 4

NO villi, but still endometrial change (high vasculature, edematous stroma) due to progesterone release

Question 5

119- Q21. How prostatectomy may result in erectile dysfunction?

Answer 5

prostate plexus is nerve plexus surrounding prostate. 
CAVERNOUS NERVE (branches off prostate plexus) mediates erection. 

prostatectomy may damage prostate plexus and thus cavernous nerve

Question 6

119- Q 23. How increased estrogen and progesterone during pregnancy result in gallstone?

Answer 6

• high estrogen -> high HMG-CoA reductase -> high cholesterol synthesis/secretion
• high progesterone -> hypomobility of gallbladder

BOTH contribute to increased incidence of gallstone during pregnancy

• Fertility is one of F for gallstone

Question 7

119- Q 26. what artery runs through spermatic cord? From which artery does it branch off?

Answer 7

gonadal artery

branch off from abdominal aorta

Question 8

119- Q 35. Uterine artery is branched off from what artery?

Answer 8

internal iliac artery

bilateral ligation of internal iliac artery is indicated for postpartum hemorrhage

Question 9

120- Q 12. Fetal abstinence syndrome

• what is it
• risk of factors
• symptoms

Answer 9

• fetus experiencing opioid withdrawal symptoms due to maternal opioid withdrawal
• maternal opioid use, maternal psychiatric disorders, poor prenatal care
• hypertonia, diarrhea, sweating, tremors, tachypnea
• this question was tough. Question did not provide history of maternal opioid use. It just provide other risk factors (HepC, history of schizophrenia , poor prenatal care) and symptoms (hypertonia, diarrhea, sweating, tremors)

Question 10

120- Q 19. Fetal placental aromatase deficiency

• phenotype of fetus
• phenotype of mom

Answer 10

• fetus
  : ambigious genitalia (if female) due to excess androgen
• mom
  : hirschitism due to androgen transferred back from fetus to maternal circulation

Question 11

120- Q 29. alpha fetoprotein is secreted from what three structures of fetus?

Answer 11

yolk sac
GI tract
liver

Question 12

120-Q 29. maternal serum alphafetoprotein screening test

• what conditions (3) are associated with high AFP
• what conditions (2) are associated with low AFP

Answer 12

• high AFP
  1. neural tube defects
  2. ventral wall defects (omphalocele, gastrochisis)
  3. multiple gestations
• low AFP
  1. trisomies (21 and 18)
  2. dating error ( maternal history of irregular menses)

Question 13

120- Q 30. skin retraction with breast cancer suggests infiltration of cancer cells into what structure of breast?

Answer 13

suspensory ligament (cooper ligament)
-> infiltration of cancer cells leads to fibrosis and retraction of overlying skin

Question 14

120- Q 31. flank pain with fever after hysterectomy. what structure is most likely injured?

Answer 14

ureter

ureter runs right below uterine artery

Question 15

120- Q 31. ureter injury during hysterecomy: will patient have issue with urination?

Answer 15

highly unlikely, unless both ureters got damaged

Question 16

120- Q 38. serum glucose state of fetus after delivery from mom with gestational diabetes

Answer 16

TRANSIENT HYPOglycemia

• maternal diabetes -> high glucose crosses placenta
• > islet cell hyperplasia in fetus (insulin does NOT cross placenta) -> hyper insulin state

=> after delivery, baby no longer receives glucose from mom, but insulin stays for few days, leading to transient HYPOglycemia

Question 17

# 121- Q 11. Mullerian agenesis vs. androgen insensitivity
\: key differences (2)?

Answer 17

• papable mass (testes) in labia marjora in androgen insensitivity, but not in Mullerian agnesis
• normal pubic hair in Mullerian agensis, but not in androgen insensitivity

Question 18

121- Q 13. Does sertoli/leydig cell tumor occur in female?

Answer 18

yes. it is one type of ovarian cancer

presents with virilization and male hair pattern in female (don’t get confused with PCOS)

Also clitoromegaly  (excess adnrogen -> excess estrogen)
=> clitoromegaly is NOT present in PCOS

Question 19

121- Q17. most common site of metastasis of choriocarcinoma?

Answer 19

lung

: may present with hemoptysis

Question 20

121- Q 21. What is imperforate hymen? How does it present clinically?

Answer 20

obstructive lesion caused by incomplete degeneration of fibrous band connecting walls of vagina

• > no outlet of uterus
• > SECONDARY AMENORRHEA
• > PALPABLE MASS (blood clot) on digital rectal exam
• uworld has good picture for this

Question 21

121- Q 30. What is amniotic fluid embolism?

Answer 21

REMNANT of FETAL SQUAMOUS CELL and MUSCIN

• > enters maternal circulation
• > occlusion of maternal pulmonary circulation
• > hypoxia and cardiopulmonary arrest (ARDS)
• > DEATH