UWorld Targeted Review: Endo/Repro

Question 1

irregularly enlarged uterus vs uniformly globular uterus

Answer 1

irregularly enlarged = leiomyoma (fibroids) —> can cause bulk-related symptoms (constipation, pelvic pressure)

uniformly globular = adenomyosis —> cause heavy menstrual bleeding

Question 2

35yo M presents with enlarged L testis + gynecomastia. Serum beta-hCG is elevated, TSH is normal. What is the cause of the gynecomastia?

Answer 2

hCG-secreting germ cell tumor —> increased Leydig cell aromatase activity + suppressed testosterone production

Question 3

name a sedating antidepressant that may cause priapism

Answer 3

trazodone - used off-label as hypnotic to treat insomnia

antagonizes post-synaptic serotonin receptors and inhibits reuptake, also has alpha blockade properties (orthostatic hypotension, priapism) and H1 blockade properties (sedating)

Question 4

which is true of choriocarcinoma:
a. proliferation of cytotrophoblasts and synctiotrophoblasts
b. contains hydropic chorionic villi

Answer 4

proliferation of cytotrophoblasts and synctiotrophoblasts WITHOUT villi (in contrast to hydatidiform mole)

Question 5

how to histologically differentiate fibroadenoma of breast from sclerosing adenosis

Answer 5

fibroadenoma = myxoid stroma

sclerosing adenosis = fibrosis and compressed/distorted acini

Question 6

49yo F w/ 10mo of irregular vaginal bleeding (post-menopausal) presents with L adnexal mass. Ovarian mass is removed and grossly appears yellow and firm. Dx?

Answer 6

granulosa cell tumor - microscopic examination will show Call-Exner bodies (neoplastic cells forming follicle-like structures around central eosinophilic material) + “coffee bean” nuclei (cuboidal cells with nuclear grooves)

produce estrogen (—> post-menopausal bleeding) and inhibin

Question 7

which of the following is endoderm?
a. pancreas
b. peritoneum
c. salivary gland
d. spleen

Answer 7

a. pancreas = endoderm (and GI tract, liver, pancreas, lungs, thymus, parathyroids, bladder, parafollicular cells)

b. peritoneum = mesoderm
c. salivary gland = surface ectoderm
d. spleen = mesoderm (and kidneys, adrenal cortex, CV/lymph, internal genitalia, muscles, connective)

Question 8

what karyotypes are possible with a complete hydatidiform mole?

Answer 8

complete mole = 1 sperm fertilizes empty ovum

chromosome of the sperm duplicates to create either 46,XX or [theoretically] 46,YY (lethal)

[partial mole = 2 sperm fertilize ovum, creating either 69,XXX or 69,XXY]

Question 9

48yo F presents w/ worsening muscle weakness -2mo. Difficulty climbing stairs and rising from chairs. She also reports 10lb weight loss and occasional abdominal discomfort. PE notable for weakness of shoulder and hip girdle muscles, as well as raised erythematous plaques over the joints and bony prominences of the hands. Further evaluation would likely reveal:
a. chronic HepC infection
b. ovarian adenocarcinoma
c. primary biliary cholangitis
d. Tropheryma whipplei infection
e. Type2 DM

Answer 9

b. ovarian adenocarcinoma

dx = dermatomyositis: systemic autoimmune disease characterized by proximal muscle weakness + skin rashes/plaques (periorbital heliotrope rash, Gottron papules)

muscle biopsy shows perifascicular inflammation

occurs alone or as paraneoplastic syndrome of adenocarcinoma (ovary, lung, pancreas)

Question 10

30yo F presents w/ irregular menses and hot flashes. Labs show low TSH. Ultrasound reveals ovarian mass, which is removed. Gross specimen shows a cystic lesion with an oily substance. Dx?

Answer 10

struma ovarii: germ cell tumor composed of 50%+ thyroid tissue (endoderm)

appears grossly as oily/sebaceous cystic mass

Question 11

_____ overexpression in breast cancer suggests a more aggressive tumor

Answer 11

HER2 overexpression in breast cancer suggests a more aggressive tumor

tx = trastuzumab

[HER2 = human epidermal growth factor receptor 2; transmembrane glycoprotein with tyrosine kinase activity]

Question 12

from what is each layer covering the spermatic cord derived? (3)

Answer 12

internal spermatic fascia - immediately overlies spermatic cord, derived from transversalis fascia

cremasteric fascia - derived from internal oblique abdominal muscle

external spermatic fascia - derived from external oblique abdominal muscle

Question 13

name a drug used to treat priapism

Answer 13

alpha agonists (phenylephrine) - induce contraction of corpora cavernous smooth muscle —> reduces venous obstruction and increases outflow

Question 14

22yo M presents w/ painless neck mass. No PMH. Mass is palpated in thyroid, and serum calcitonin is elevated. There are multiple soft papules on the lips and tongue. The arm span exceeds height. Dx?

Answer 14

MEN 2B: medullary thyroid cancer (calcitonin) + pheochromocytoma + mucosal neuromas + marfanoid habitus

Question 15

how are serum testosterone, LH, and FSH levels affected by androgen insensitivity vs exogenous androgen use?

Answer 15

androgen insensitivity: high testosterone, high LH (lack of neg. feedback), normal FSH

exogenous androgens: high/normal testosterone, low LH (a lot of neg. feedback), normal FSH

Question 16

which form of congenital adrenal hyperplasia presents with ambiguous genitalia in BOYS?

Answer 16

17 alpha-hydroxylase —> HTN with hypokalemia + ambiguous genitalia in boys with absent puberty

Question 17

Leydig cells in males are analogous to ____ in females

Answer 17

Leydig cells (males) = theca interna (females)

both are stimulated by LH to produce androgens (testosterone)

in females, this is then converted via aromatase in granulosa cells to estradiol (under FSH stimulation)

Question 18

to what does the R vs L ovarian vein drain into?

Answer 18

R ovarian vein —> IVC

L ovarian vein —> L renal vein (then IVC)

Question 19

elevated serum ____ confirms diagnosis of menopause

Answer 19

FSH

Question 20

presentation of Marfan syndrome vs MEN 2B

Answer 20

Marfan: aortic malformations (dilation), ectopia lentis

MEN 2B: medullary thyroid cancer (calcitonin), pheochromocytoma, mucosal neuromas

both present with marfanoid habitus

Question 21

which anti-diabetic medications induce weight loss? (2)

Answer 21

1. GLP-1 agonists (exenatide, liraglutide) - via delayed gastric emptying
2. SGLT-2 inhibitors (-gliflozin) - via glucosuria

Question 22

what is the function of the gene that is mutated in medullary thyroid cancer and pheochromocytoma?

Answer 22

RET: proto-oncogene, encodes for membrane-bound tyrosine kinase receptor

Question 23

which type of anti-diabetic drug can cause hypoglycemia with elevated C-peptide levels?

Answer 23

C-peptide = endogenous insulin production

sulfonylureas are insulin secretagogues

Question 24

name a drug used to treat BPH that causes decreased libido and ED

Answer 24

finasteride: 5-alpha-reductase inhibitor

reduces conversion of testosterone to DHT —> decreased prostate volume

may also cause gynecomastia due to increased peripheral aromatization

Question 25

what occurs from failure of vertical fusion of the paramesonephric ducts with the urogenital sinus?

Answer 25

transverse vaginal septum - causes primary amenorrhea and cyclic pelvic pain due to retained menses in uterus

Question 26

which of the following should be periodically monitored in patients receiving testosterone therapy?
a. ECG
b. hematocrit
c. serum cortisol
d. serum creatinine
e. serum TSH

Answer 26

b. hematocrit - testosterone can induce erythrocytosis

this can increase blood viscosity and elevate risk for thromboembolism

Question 27

Immunohistochemical stain of ____ is negative in complete moles because of the absence of a maternal genome

Answer 27

p57

Question 28

what is the difference in presentation of placenta accreta and abruptio placentae?

Answer 28

placenta accreta - abnormal invasion of trophoblast into uterine myometrium, causes heavy vaginal bleeding after fetal delivery when the placenta does not detach from the uterine wall

abruptio placentae - premature separation of the placenta and myometrium, causes heavy vaginal bleeding and a tender, firm uterus because of blood accumulation between the placenta and uterine wall

Question 29

cause of acute scrotal pain that is relieved with manual elevation of the testicle =

Answer 29

Epididymitis - caused by infection (gonorrhea) or trauma

Question 30

invasive breast carcinoma can cause skin retractions/puckering due to involvement of…

Answer 30

Suspensory ligaments of the breast (Cooper ligaments)

Question 31

eczematous plaque and itchy rash on the nipple should raise suspicion for…

Answer 31

Paget disease of the breast - malignant breast condition characterized by unilateral, painful, pruritic, eczematous rash confined to the nipple and areola; scaling and ulceration is also seen

Caused by spread of an underlying breast malignancy to the nipple surface