Rx_1.29 (Reproductive)

Question 1

Drugs used in medical abortion

Answer 1

1. mifepristone = progesterone antagonist
   
   1. ==> uninhabitable/unsustainable uterine environment for fetus
2. misoprostol (taken a few days after mifepristone) = prostaglandin E₁ analog
   
   1. ==> uterine contraction and expulsion of fetal remnants

Question 2

Most important risk factor for development of cervical cancer

Answer 2

• most important = early onset of sexual activity
• others
  
  • multiple sexual partners
  • smoking
  • low socioeconomic status
• association with high risk HPV virus (16, 18)

Question 3

Congenital Adrenal Hyperplasia presentation/mechanism

Answer 3

• 21-alpha-hydroxylase deficiency ==> failure to produce aldosterone and cortixol + (shuttling of intermediates =>) increased androgen production
• ambigous genitalia
• hypotension
• hypovolemia
• hyperkalemia

Question 4

Adrenal steroid synthesis pathways

Answer 4

• Aldosterone (Salt) [@ Zona Glomerulosa]
  
  • Chlosterol ==> Pregnenolone ==> Progesterone ==(21a-hydroxylase)==> 11-deoxycorticosterone ==(11B-hydroxylase)==> corticosterone ==> aldosterone
• Cortisol (Sugar) [@ Zona fasciculata]
  
  • Chlosterol ==> Pregnenolone ==(17a-hydroxylase)==> 17-hydroxypregnenlolone ==> 17-hydroxyprogesterone OR
  • Progesterone ==(17a-hydroxylase)==> 17-hydroxyprogesterone ==(21a-hydroxylase)==> 11-deoxycortisol ==(11B-hydroxylase)==> cortisol
• Androgens (Sex) [@ Zona Reticularis]
  
  • Chlosterol ==> Pregnenolone ==(17a-hydroxylase)==> 17-hydroxypregnenlolone ==> DHEA ==> Androstenedione ==> Testosterone
    
    • Androstenedione ==(aromatase)==> estrone
  • Progesterone ==(17a-hydroxylase)==> 17-hydroxyprogesterone ==> Androstenedione ==> Testosterone
  • Testosterone ==(aromatase)==> estradiol
  • Testosterone ==(5a-reductase)==> DHT (dihydrotestosterone)

Question 5

Presentation of intraductal papilloma

Answer 5

• = tumor of lactiferous ducts
• presents w/bloody discharge from nipple (most common cause)

Question 6

Mastitis presentation

Answer 6

• associated w/breastfeeding
• chronic mastitis can occur @ postmenopausal women due to inflammation of ducts beneath nipple
• presentation
  
  • breast erythema, engorgement, tenderness
  • fever, chills

Question 7

Cardinal ligament location/significance

Answer 7

• located @ base of broad ligaments
• contain the uterine arteries and veins
  
  • internal iliac ==> uterine artery ==> uterus

Question 8

Location of ovarian arteries

Answer 8

Within infundibulopelvic ligament (aka suspensory ligament of the ovaries)

Question 9

Histologic quality of endometrium during the menstrual cycle

Answer 9

• proliferative phase = estrogen driven
• secretory phase = progesterone driven

Question 10

Location of sperm development/genetic content at various locations

Answer 10

• sperm develop from the outside of the tubule inward
  
  • spermatogonium (2N) = @ basal side
  • spermatid (N) = @ apical-side
• spermatocytes (4N) = slightly more apical than spermatogonium

Question 11

Presentation/Tx of PID

Answer 11

• Presentation
  
  • purulent vaginal discharge
  • lower abdominal pain
  • fever
  • cervical motion tenderness
  • [often hx of unprotected sex]
• Tx
  
  • Certriaxone ==> gonorrhea
  • Azithromycin ==> chlamydia

Question 12

Presentation of 5a-reductase deficiency

Answer 12

• genotypic male born w/ambigous genitalia
  
  • male internal gneitalia
  • ambiguous/female-appearing external genitalia
  • most raised as girls
• puberty ==> increased testosterone ==> masculinization of external genitalia
  
  • “penis-at-12” phenomenon
• LH and Testosterone levels elevated
• 5a-reductase: converts T ==> dihydrotestosterone (DHT) = necessary for normal development of male external genitalia in utero

Question 13

Tamsulocin: MOA

Phenasteride: MOA

Answer 13

• Tamsulocin = alpha-1 antagonist