Study guide & Fellow review Flashcards
AMH is AKA __
mullerian inhibiting substance (MIS)
Mullerian duct becomes:
tubes, uterus, upper 1/3 vagina
Wolffian duct becomes:
epididymus, vas deferens, seminal vesicles
What does Mullerian NOT become?
ovaries, lower vagina, clitoris
What does Wolffian duct NOT become?
testes, penis
main 2 ddx for absence of uterus
mullian agenesis, androgen insensitivity
What do sertoli cells produce
MIS
What do Leydig cells produce
testosterone
Swyers syndrome
XY, mutation in SRY gene, phenotypically female
Gonads in Swyers?
streak
androgen insensitvity
female phenotype but no ovaries, scant pubic hair, breast development (aromatization from T), male T level
Defect in MRKH
mutation in AMH gene or receptor
heritability of 5 alpha reductase deficiency
autosomal recessive
which DSD most likely to have gender dysphoria
5-ARD (grow penis at puberty)
What test do your order to r/o CAH
17-ohp
order of female puberty
breast (thelarche), pubic hair (adrelarchy), growth spurt,
menarche, (“TAG-men”)
When should menses occur by? (define delayed puberty)
13 w/o breast, 15 if secondary sex
short stature, webbed neck, shield chest, streak gonads
Turner’s
precocious puberty, cafe au lait spots, increased bone age
McCune Albright (upstream production of estrogen due to G protein mutations)
treatment for McCune Albright
aromatase inhibitors - testalactone (shut down production of estradiol)
definition of precocious puberty in girls
under 6 in black, under 7 in white
Can put precocious puberty kids on __ to prevent early growth plate fusing
lupron
Why do GnRH agonists & antagonists work to prevent LH/FSH secretion?
activation requires pulsatile action
How to improve IVF success with hydrosalpinx?
salpingectomy or occlude tubes before IVF
treatment for labial adhesion
estrogen cream (NOT surgical)
What vaccine do you NOT GET within 3 weeks before IVF
MMR (bc contraindicated in pregnancy)
What infectious disease does treating BV help prevent?
STDs, including HIV
22 yo w primary ovarian insufficiency w/ bone fractures, considering pregnancy, how to treat osteoporosis?
hormone replacement (don’t forget calcium, vitamin D)
mutations associated with lynch syndrome
MLH1, PMS2, MSH2, MSH6 - microsatellite instability, germ line mutation in DNA mismatch repair gene
most common presentation of fallopian tube carcinoma
postmenopausal bleeding or copious clear discharge
male to female transition at most risk of what disease?
pro-thrombotic – hyperlipidemia, PE
During HSG you see b/l distal occlusion, what do you do?
Give doxycycline x5 days
risk for SCD in pregnancy
anemia - can’t increase RBC mass as normal
HPV type most at risk for adenocarcinoma of cervix
18
If BV and has allergey to flagyl, what med?
intravaginal clindamycin
NIPT cell free DNA comes from what source?
trophoblasts
Peak bone mass is determined by:
genetics
why don’t we see ovarian hyperstimulation syndrome anymore
use lupron trigger now instead of hcg
In a hypo hypo patient how to do ovulation induction?
FSH
how does clomiphene work
SERM
how does letrozole work
shuts down aromatization, body thinks no estrogen
PCOS ovulation induction
letrozole
How does estrogen increase bone density
inhibits osteoclasts
changes after menopause (up, down, same): T, androstenedione, SHBG, estradiol, estrone
T: down
androstenedione: down
SHBG (sex hormone binding globulin): down - so can have increased free E & T
estradiol: down
estrone: down (but relative proportion is higher)
most success for fertility protocol: mature oocyte, immature, oocyte, tissue cryo?
mature oocyte
incidence of CF highest in what ethnic group
white
most common mutation in CF
delta F508
age to start DXA scan
65
CAH how inherited? What gene?
autosomal recessive, CYP2…
what is associated with mild hyperprolactinemia?
endometriosis
subfascial hematoma after myomectomy - what artery injured?
inferior epigastric artery
normal cysto after surgery but found to be damaged later - why?
thermal spread
How to differentiate theca lutein cysts vs luteomas
theca lutein cysts bilateral (result of HCG - twin pregnancy, molar pregnancy)
luteoma usually unilateral
What is the ethical appeal behind no longer assigning female gender with surgery in the setting of ambiguous genitalia at birth? (autonomy, justice, beneficence, non maleficence)
autonomy
first lab to get in workup of acromegaly?
IGF1
buzzword: imprinting disorder in context of artificial reproductive technology
ICSI
examples of imprinting disorder
Prader willi, angelman
when do mono mono twins separate?
8-13 days (1-2 weeks)
AGC on pap, normal colpo, normal ECC, normal EMB, next step?
cotest 12 months, but we think D&C
infectious risk highest w what osteoporosis med
denosumab (skin infections & eczema)
osteoprosis med with concern for renal damage
zoledronic acid
most common bug in pyelo
E coli
breast cancer with dermal ducts, what type
inflammatory breast cancer
pt with endometrial hyperplasia, what type of hyst do you recommend?
vag hyst
split in di-di twins?
0-3 days
what kind of breast cancer has peritoneal implants?
lobular invasive
what is receptor status of brca1-2 related breast cancer?
triple negative
treatment of choice for pt with twin twin transufation
laser
Is toxic shock due to endo or exo toxin?
strep pyogenes exotoxins
paclitaxel MOA
stabilize microtubules
which is most sensitive to radiation? (large bowel, small bowel, bladder)
small bowel
MOA immiquimod
immune modulate
if get sued new or old company or you pays?
old company if you have tail insurance
Pt hasn’t seen you in 5 years
bill as new pt
blueberry muffin rash
CMV
CMV avidity testing reveals both IgM, IgG positive with high avidity - immune, acute, chronic?
re-infection w different strain or reactivation
Who put together national practitioner database?
Congress
safest hypnotic in elderly? (ativan, xanax, valium, ambien)
avoid benzos!
cervical cancer marker p53? RB
E6 inactivates p53
E7 inactivate Rb
what causes elevated tryptase levels?
allergic reaction
