Rx_1.26 (Reproductive)

Question 1

Ringworm (tinea corpis) tx + MOA + SE

Answer 1

• ketoconazole
• MOA = blocks formation of fungal membrane sterols
• SE = endocrine effects
  
  • blocks CYP450scc/desmolase = necc. for testerone and cortisol from cholesterol
  • decreased cortisol ==> decreased inhibition of POMC ==> increased synth of ACTH, melanocyte-stimulating hormone, endorphins ==> skin darkening

Question 2

Penile venous outflow abnormalities ==>

Answer 2

• erectile dysfxn
• normal = blood flow accelerates into corpus cavernosum ==> blockage of venous outflow ==> erection
• abnormalities usually due to insufficient relation of smooth m. from excess adrenergic tone or damaged parasympathetic
• leak from dorsal vein ==> saphenous vein ==> inability to maintain erection

Question 3

Normal vaginal pH

Answer 3

3.8-4.5

Question 4

Vaginitis w/vulvar pruritis + discharge + [image] ==> Dx?

Answer 4

vulvovaginal candidiasis

Question 5

Common vaginal infections and impact on vaginal pH

Answer 5

• candida = normal pH (<4.5)
• bacterial vaginosis ==> 5.0 - 6.0
• trichomonas ==> 5.0-7.0
• vaginal pH = 8.0 ==> suspicious for contamination w/cervical mucus or sperm

Question 6

Neonate w/hepatosplenomegaly, ascites, peripheral edema, purpura ==> dx?

Answer 6

• hydrops fetalis = consequence of severe hemolytic disease of the newborn
• mechanism:
  
  • Rh-negative mother w/previous Rh-positive child ==> sensitization
  • if next child = Rh-positive ==> maternal IgG crosses placenta attacks fetal RBCs

Question 7

Characteristics of seminoma

Answer 7

• most common testicular neoplasm
• common @ 15-35yo
• painless presenation
• radiosensitive
• pathology =
  
  • large cells in lobules w/watery cytoplasm
  • “fried egg” appearance

Question 8

testicular mass w/glandular/papillary morphological pattern ==> dx?

Answer 8

• embryonal carcinoma
• [usually painful]

Question 9

cowdry type A nuclear inclusions ==> dx?

Answer 9

CMV infection

Question 10

testicular mass w/Reinke’s crystals ==> dx?

Answer 10

• Leydig’s cell tumors
• usually produce androgens ==> gynecomastia in men or precocious puberty in boys
• non-germ cell tumor

Question 11

testicular mass w/structures resembling primitive glomeruli ==> dx?

Answer 11

• yolk sac tumors
• “schiller-duval bodies” = structures resembling primitive glomeruli

Question 12

Structure of cilia + common defect

Answer 12

• central pair of microtubules w/ nin surrounding pairs w/dynein arms that create “sweeping motion”
• dynein defect ==> Kartagener’s syndrome
  
  • poor mucous clearance ==> chronic sinus infections
  • infertility
  • assoc. w/situs inversus

Question 13

Normal vaginal flora + fxn

Answer 13

• lactobacilli = gram-positive facultative anaerobes
  
  • help maintain acidic vaginal pH (3.5-4.2)
  • loss of bacteria (e.g. during a course of antibiotic tx) ==> slight increase in vaginal pH ==> growth of candida (yeast infection)

Question 14

Pharm tx for HER2 (human epidermal growth factor) breast cancer cells

Answer 14

• Trastuzumab = monoclonal antibody agains HER2

Question 15

Tamoxifen use

Answer 15

• chemotherapeutic agent @ estrogen receptor-positive breast cancer
• selective antagonist ==> inhibition of production of estrogen-responsive genes

Question 16

Common lymphatic spread of testicular tumors

Answer 16

==> paraaortic chain of lymph nodes

Question 17

Components of male urethra

Answer 17

• prostatic urethra (runs through prostate)
• membranous urethra (runs through urogeneital diaphragm)
• penile urethra (runs through penis)

Question 18

consequences of rupture of urethra below the urogenital diaphragm (males)

Answer 18

• rupture @ jxn of membranous and penile urethra ==> urine into scrotum and perineal region
• “straddle injury”

Question 19

Characteristics of fibroadenomas

Answer 19

• most common breast mass in young women
• histologic appearance
  
  • fibrosing interlobular stroma around normal duct and gland architecture

Question 20

Large cells w/clear “halos” on breast biopsy ==> dx?

Answer 20

Paget disease = eczematous skin findings around nipple associated w/underlying ductal carcinomas

Question 21

Branching fibrovascular core extending from a dilated duct on breast biopsy ==> dx?

Answer 21

• intraductal papilloma = benign solitary lesions that line lactiferous ducts
• ==> serosanguinous (serous fluid or blood) and unilateral nipple discharge

Question 22

Parallel arrays of small, monomorphic cells w/scant cytoplams on breast biopsy ==> dx?

Answer 22

• infiltrating lobular carcinoma
• irregular mass on palpation
• common @ postmenopausal women

Question 23

Sheets of pleomorphic cells infiltrating adjacent stroma on breast biopsy ==> dx?

Answer 23

• invasive ductal carcinoma = most common mass in older women
• ==> overlying skin changes; e.g. pigmented dimpling or unilateral bloody nipple discharge
• palpation = firm, irregular, fixed masses
• mammography = multiple small calcifications

Question 24

Presentation of congenital adrenal hyperplasia

Answer 24

• 21-hydroxylase deficiency ==>
  
  • inability to convert steroid precursors to aldosterone or cortisol
• excess substrate ==> androgen production ==>
  
  • ambigous (virilized) genitals
• low aldosterone/cortisol ==>
  
  • renal salt wasting (hyponatremia)
  • hypotension
  • hyperkalemia

Question 25

Substrate of 21-hydroxylase

Answer 25

• 17-hydroxyprogesterone <== will build up in 21-hydroxylase deficiency

Question 26

Ovarian biopsy ==> Dx?

Answer 26

• Brenner’s tumor = benign ovarian tumor composed of cells resembling bladder transitional epithelium

Question 27

Edward’s syndrome (Trisomy 18): AFP, B-HCG, estriol, inhibin A

Answer 27

• AFP = low
• B-HCG = low
• estriol = low
• inhibin A = normal

Question 28

Patau syndrome (Trisomy 13): AFP, B-HCG, estriol, inhibin A

Answer 28

• AFP = normal
• B-HCG = normal
• estriol = normal
• inhibin A = normal