UWorld Targeted Review: Endo/Repro Flashcards
irregularly enlarged uterus vs uniformly globular uterus
irregularly enlarged = leiomyoma (fibroids) —> can cause bulk-related symptoms (constipation, pelvic pressure)
uniformly globular = adenomyosis —> cause heavy menstrual bleeding
35yo M presents with enlarged L testis + gynecomastia. Serum beta-hCG is elevated, TSH is normal. What is the cause of the gynecomastia?
hCG-secreting germ cell tumor —> increased Leydig cell aromatase activity + suppressed testosterone production
name a sedating antidepressant that may cause priapism
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)
which is true of choriocarcinoma:
a. proliferation of cytotrophoblasts and synctiotrophoblasts
b. contains hydropic chorionic villi
proliferation of cytotrophoblasts and synctiotrophoblasts WITHOUT villi (in contrast to hydatidiform mole)
how to histologically differentiate fibroadenoma of breast from sclerosing adenosis
fibroadenoma = myxoid stroma
sclerosing adenosis = fibrosis and compressed/distorted acini
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?
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
which of the following is endoderm?
a. pancreas
b. peritoneum
c. salivary gland
d. spleen
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)
what karyotypes are possible with a complete hydatidiform mole?
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]
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
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)
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?
struma ovarii: germ cell tumor composed of 50%+ thyroid tissue (endoderm)
appears grossly as oily/sebaceous cystic mass
_____ overexpression in breast cancer suggests a more aggressive tumor
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]
from what is each layer covering the spermatic cord derived? (3)
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
name a drug used to treat priapism
alpha agonists (phenylephrine) - induce contraction of corpora cavernous smooth muscle —> reduces venous obstruction and increases outflow
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?
MEN 2B: medullary thyroid cancer (calcitonin) + pheochromocytoma + mucosal neuromas + marfanoid habitus
how are serum testosterone, LH, and FSH levels affected by androgen insensitivity vs exogenous androgen use?
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
which form of congenital adrenal hyperplasia presents with ambiguous genitalia in BOYS?
17 alpha-hydroxylase —> HTN with hypokalemia + ambiguous genitalia in boys with absent puberty
Leydig cells in males are analogous to ____ in females
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)
to what does the R vs L ovarian vein drain into?
R ovarian vein —> IVC
L ovarian vein —> L renal vein (then IVC)
elevated serum ____ confirms diagnosis of menopause
FSH
presentation of Marfan syndrome vs MEN 2B
Marfan: aortic malformations (dilation), ectopia lentis
MEN 2B: medullary thyroid cancer (calcitonin), pheochromocytoma, mucosal neuromas
both present with marfanoid habitus
which anti-diabetic medications induce weight loss? (2)
- GLP-1 agonists (exenatide, liraglutide) - via delayed gastric emptying
- SGLT-2 inhibitors (-gliflozin) - via glucosuria
what is the function of the gene that is mutated in medullary thyroid cancer and pheochromocytoma?
RET: proto-oncogene, encodes for membrane-bound tyrosine kinase receptor
which type of anti-diabetic drug can cause hypoglycemia with elevated C-peptide levels?
C-peptide = endogenous insulin production
sulfonylureas are insulin secretagogues
name a drug used to treat BPH that causes decreased libido and ED
finasteride: 5-alpha-reductase inhibitor
reduces conversion of testosterone to DHT —> decreased prostate volume
may also cause gynecomastia due to increased peripheral aromatization
what occurs from failure of vertical fusion of the paramesonephric ducts with the urogenital sinus?
transverse vaginal septum - causes primary amenorrhea and cyclic pelvic pain due to retained menses in uterus
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
b. hematocrit - testosterone can induce erythrocytosis
this can increase blood viscosity and elevate risk for thromboembolism
Immunohistochemical stain of ____ is negative in complete moles because of the absence of a maternal genome
p57
what is the difference in presentation of placenta accreta and abruptio placentae?
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
cause of acute scrotal pain that is relieved with manual elevation of the testicle =
Epididymitis - caused by infection (gonorrhea) or trauma
invasive breast carcinoma can cause skin retractions/puckering due to involvement of…
Suspensory ligaments of the breast (Cooper ligaments)
eczematous plaque and itchy rash on the nipple should raise suspicion for…
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
