Rx_1.27 (Reproductive)

Question 1

Formation of gametes in female

Answer 1

• Primordial germ cells differentiate into oogonia during embryonic period
• oogonia replicate DNA and then enter prophase I = primary oocyte
  
  • occurs by 5 months of fetal development
• oocytes remain arrested in prophae I until stimulated just prior to ovulation by FSH
• oocytes ==> metaphase II + LH surge ==> ovulation
• oocytes arrested @ metaphase II until fertilization

Question 2

Consequences of PCOS

Answer 2

• oligo/anovulation + hyperandrogenism
• excess LH + androgens
• features
  
  • ovarian cysts
  • amenorrhea
  • intertility
  • obesity
  • hirsutism
• associated w/insulin resistance (hyperglycemia) and hyperinsulinemia
• ==> amenhorrea and infertility

Question 3

Standard management of PCOS

Answer 3

• weight loss
• OCPs
• gonadotropin-releasing hormone analogs
• tx of insulin resistance

Question 4

Virulence mediator in gonorrhoeae

Answer 4

• presentation = gram (-) diplococci w/in PMNs
• variable antigenic pili ==> attachment to mucosal surfaces
  
  • variation in antigens aids in evasion of host defenses

Question 5

Twins in utero:

division w/in 3 days

division between 4-8 days

division between 8-12 days

Answer 5

• division w/in 3 days ==>
  
  • monozygotic OR dizygotic twins
  • diamniotic
  • dichorionic
  • 2 placentas
• division @ 4-8 days ==>
  
  • monozygotic twins
  • diamniotic
  • monochorionic
  • one placenta
• division @ 8-12 days ==>
  
  • monozygotic twins
  • monoamniotic
  • monochorionic
  • one placenta

Question 6

Hormone necessary for development of external genitalia in males

Answer 6

• dihydrotestosterone (DHT)
  
  • Testosterone ==5a-reductase==> DHT

Question 7

Fxn of FSH and LH in males

Answer 7

• FSH ==> maintains spermatogenesis
• LH ==> acts at testes to stimulate testosterone production

Question 8

Fxn of Mullerian inhibiting factor and testosterone in males in utero

Answer 8

• MIF ==> regression/prevention of formation of female internal genital organs from Mullerian ducts
• Testosterone ==> maintenance of Wolffian ducts in males ==> form male urogenital organs

Question 9

Preeclampsia presentation

Answer 9

• classic triad = HTN, edema, proteinuria in pregnant patietns >20 weaks
• more common @ patients w/DM, chronic renal dz, autoimmune, pre-existing HTN

Question 10

Signs of severe preeclampsia

Answer 10

• HELLP:
• Hemolysis
• Elevated Liver fxn tests
• Low Platelets

Question 11

Dx of eclampsia

Answer 11

• preeclampsia + maternal seizures
  
  • can be dx via EEG

Question 12

Tx of preeclampsia

Answer 12

• antihypertensives
• deliver @ 34 wks (if severe) or @ 37 wks (if mild)
• IV magnesium sulfate to prevent seizures

Question 13

Vaginal bleeding at postmenopausal women ==>?

Answer 13

cancer [endometrial carcinoma] until proven otherwise

Question 14

Which cell is indicated by the arrow [w/in seminiferous tubules]?

Answer 14

• Sertoli cell = supportive/nutritive role in spmatogenesis but is not spermatogenic

Question 15

Nonspermatogenic cells @ seminferous tubules + roles/location

Answer 15

• Sertoli cells
  
  • location: line seminferous tubules
  • in utero: secrete MIF
  • secrete inhibin ==> inhibit FSH
  • support/nourish spermatozoa
  • regulate local levels of androgens
    
    • convert T ==> estrogen (via aromatase)
• Leydig cells
  
  • location: interstitium
  • Secrete testosterone in presence of LH

Question 16

Most specific test for dx of syphillis

Answer 16

Flourescent treponemal antibody absorption test

Question 17

Wil-Felix rxn =

Answer 17

• classic test for rickettsial infection
• e.g. Rocky Mountain spotted fever