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Foundational Capstone (April 2015 M2) > 02/24/15 - Reproductive > Flashcards

Flashcards in 02/24/15 - Reproductive Deck (42)
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1

A 32yo African-american woman reports painful cramping during menses and periods lasting up to 10 days. Ultrasound shows multiple uterine masses. Which IHC stain should be used to confirm diagnosis on biopsy?

A. Cytokeratin
B. Desmin
C. GFAP
D. Neurofilament
E. Vimentin

B. Desmin

These are uterine fibroids (leiomyomas); they are comprised of smooth musccle which stain for desmin. Cytokeratin is for epithelium, GFAP for some neuroglia, neurofilament stains for neurons, and vimentin for connective tissue.

2

A 68yo man reports nocturia and difficulty starting urination. His PSA was normal, but his prostate is enlarged. What should his doctor prescribe?

A. Finasteride
B. Flutamide
C. Ketoconazole
D. Spironolactone
E. Yohimbine

A. Finasteride

This is BPH; recall that it results from the effect of DHT on the prostate. Finasteride, being a 5a-reductase inhibitor, would slow the progression of this condition.

3

A 3yo has a history of recurrent sinus infections. On auscultation, his heart is heard on the right side of his body. This congenital disorder could also cause him to have which of the following?

A. Defective chloride transport
B. Elevated blood sugar
C. Infertility
D. Reactive airway disease
E. Tetralogy of Fallot

C. Infertility

This is Kartagener's syndrome; a defect in dynein results in immotile cilia leading to sinusitis, situs inversus, bronchiectasis and male infertility.

4

A baby is born who is small for gestational age and smells musty. The mother was consuming large amounts of diet soda. An amino acid screen notes deficiency of which of the following?

A. Cysteine
B. Glutamine
C. Phenylalanine
D. Proline
E. Tyrosine

E. Tyrosine

This is phenylketonuria; phenylalanine (from the diet soda) cannot be converted to tyrosine. The musty odor is a result of the phenylalanine accumulation.

5

 In testicular feminization syndrome, androgens are produced but cells don't respond to them because they lack appropriate intracellular recepotrs. What do steroids regulate the rate of after binding?

A. Protein synthesis initiation
B. mRNA degradation
C. mRNA processing
D. Protein translation
E. Gene transcription

E. Gene transcription

This is true of all steroids, though some may have cell surface receptors as well. 

6

3 hours after birth, a premature infant (28weeks gestation) is in respiratory distress with RR 56, nasal flaring, and retractions. What is deficient in his lungs?

A. Angiotensin-converting enzyme
B. Collagen
C. Dipalmitoyl phosphatidylcholine
D. Elastase
E. Functional cilia

C. Dipalmitoyl phosphatidylcholine

This is neonatal respiratory distress syndrome (neonatal atelectasis); the infant has not produced adequate surfactant (from Type II pneumocytes), of which phosphatidylcholine is a component.

7

A newborn male has a urethral meatus opening on the ventral side of the penis. What is the cause of this malformation?

A. Failure of urethral fold fusion
B. Failure of urethrorectal septum formation
C. Maldevelopment of the urinary sphincters
D. A shortened urethra
E. A urethral stricture

A. Failure of urethral fold fusion

This is hypospadias, which results from failure of fusion of the urethral folds. Recall that the other genital precursors are the labioscrotal swelling and genital tubercle (which fails to fuse in epispadias).

8

A 17yo female with a history of aortic coarctation presents with Tanner stage 2 breast and pubic development, with absent menarche. Which of the following is most likely to be found?

A. Low levels of estrogen
B. Normal ovaries
C. Patent ductus arteriosus
D. Simian crease
E. 46XY karyotype

A. Low levels of estrogen

This is Turner's syndrome; these patients exhibit streak ovaries that are not fully hormono-competent. Simian crease indicates Down syndrome. The karyotype in Turner's is 45XO.

9

A 27yo female presents with a painful labial vesicle and bilateral inguinal lymphadenopathy. She is sexually active. Tzanck, VDRL, and viral-PCR are negative. What medication do you prescribe the patient?

A. Acyclovir
B. Ceftriaxone
C. Foscarnet
D. Analgesic only
E. Vancomycin

B. Ceftriaxone

This is chancroid (from Haemophilus Ducreyi), which should be treated with antibiotics that affect gram-negatives. Acyclovir and foscarnet are for viral infections. Vancomycin is ill-advised.

10

A teenage boy presents with a genital rash extending to the abdomen. He has numerous small, flesh colored nodules with central umbilication. What type of virus is responsible for this?

A. HSV-1
B. HHV-8
C. Poxvirus
D. Rubeola virus
E. VZV

C. Poxvirus

This is molluscum contagiosum; note the painless flesh-colored nodules. HHV-8 and Rubeolavirus do not affect the genitalia. Herpesvirus STIs are generally erythematous.

11

A 22yo menstruating female presents with fever, hypotension, and a diffuse macular rash. Her tampon is cultured and grows a catalase-positive, gram-positive cocci. Her rash has begun to desquamate. What is the causative organism?

A. Actinomyces israelii
B. Clostridium perfringens
C. Proteus mirabilis
D. Staphylococcus aureus
E. Streptococcus pyogenes

D. Staphylococcus aureus

This is a classic case of staph toxic shock syndrome. Strep can also cause a toxic shock but does not cause the scalded skin syndrome and is not catalase positive.

12

A 23yo pregnant female reports painful bumps on her genitals. Vesicles are seen on exam. Which of the following tests would indicate risk of congenital anomalies for the fetus?

A. Anti-Hep B surface antibody
B. Giemsa stain for cytoplasmic inclusions
C. Monospot test
D. Tzanck smear for multinucleated giant cells
E. Weil-felix test

D. Tzanck smear for multinucleated giant cells

Tzanck test looks for giant cells seen in CMV, HIV, and many herpesviridae. Of these, Herpes can present with painful genital lesions and is a member of TORCH. HepB does not cause congenital anomalies. Giemsa stain looks for chlamydia (no genital vesicles), monospot looks for EBV (no genital vesicles), and Weil-Felix is for typhus or Rocky mountain spotted fever.

13

A 70yo male with dementia is brought in for evaluation of hematuria. He has lost weight, denies pain, and shows invasive transitional cells with atypical nuclei and mitotic spindles on bladder biopsy. Which off the following risk factors has the strongest association with his disease?

A. Aniline dye exposure
B. Prior cyclophosphamide treatment
C. Heavy cigarette smoking
D. History of pelvic irradiation
E. Prior schistosomiasis infection

C. Heavy cigarette smoking

Bladder cancer is one of the many promoted by smoking. All of the other listed factors can cause bladder cancer, but pale in comparison to smoking as risk factors.

14

A 68yo man has difficulty with urinary frequency and hesitancy due to BPH. He says finasteride is working, and asks how the drug works. Your answer?

A. Forms superoxides that attack DNA
B. Gonadotropin releasing hormone analog
C. Inhibition of PDE-5
D. Inhibition of 5a-reductase
E. Inhibits cytochrome P450s
F. Inhibits testosterone's negative feedback on gonadotropin secretion.

D. Inhibition of 5a-reductase

A describes bleomycin, B describes leuprolide, C describes sildenafil, E describes lots of things that aren't finasteride (eg Ketoconazole), and F describes flutamide.

15

A 32yo female from Peru reports with an unplaned pregnancy. You notice that her tears are orange. Her OCP was less effective due to an interaction with treatment for which of the following?

A. Breast cancer
B. Epilepsy
C. Giardia
D. Refractory A-fib
E. Tuberculosis

E. Tuberculosis

Orange body fluids are a notable side effect of Rifampin, which is one of the 3-5 drugs used to treat tuberculosis. It is also a P450 inducer.

16

A patient is experiencing hot flashes and is considering hormone replacement therapy. What other benefits may it confer?

A. Decrease risk of breast cancer
B. Decrease risk of DVT
C. Decrease risk of hip fractures
D. Decrease risk of heart attacks
E. Decrease risk of strokes

C. Decrease risk of hip fractures

Estrogen HRT is effective in treating vasomotor symptoms and preventing osteoporosis. It probably increases CV events, and may increase risk of breast cancer.

17

Which of the following structures lies inside the inguinal canal but outside of the spermatic cord?

A. Ductus deferens
B. Ilioinguinal nerve
C. Pampiniform plexus
D. Testicular artery
E. Testicular lymphatic vessels

B. Ilioinguinal nerve

Recall the contents of the spermatic cord with the nmemonic "All Doctors Love Taking Care of Patients Genitals"; Artery to the ductus, Ductus deferens, Lymphatics, Testicular artery, Cremaster muscle, Pampiniform plexus, Genitofemoral nerve (not ilioinguinal!)

18

Which of the following symptoms changes a diagnosis of pre-eclampsia to eclampsia?

A. Edema
B. Hyperreflexia
C. Hypertension
D. Proteinuria
E. Seizures
F. Hypomagnesemia

E. Seizures

19

A 27yo African-american is found to have uterine masses. Biopsy shows a whorled pattern of smooth muscle. What is the most common characteristic of these masses?

A. Enlarges with menopause
B. Enlarges with pregnancy
C. Forms chocolate cysts
D. Malignant transformation
E. Necrosis and hemorrhage

B. Enlargement with pregnancy

This is leiomyoma (fibroid); they are estrogen sensitive and grow during pregnancy.

20

Destruction of the hypothalamus or administration or a dopamine-blocking antipsychotic causes a specific hormone to rise. What hormone is it?

A. ADH
B. Growth hormone
C. Luteinizing hormone
D. Oxytocin
E. Prolactin
F. Thyroid releasing hormone

E. Prolactin

Recall that "Prolactin inhibiting factor" is actually dopamine released from the hypothalamus to inhibit prolactin release at the adenohypophysis.

21

A patient presents with testicular tumor whose bloodwork shows a serum alpha-fetoprotein that is 3x the upper limit of normal. How old is this patient?

A. 0-3yrs
B. 10-20yrs
C. 20-30yrs
D. 30-40yrs
E. 40-50yrs

A. 0-3yrs

This is a yolk sac tumor; recall that they tend to occur very early in life.

22

What structure supplies the majority of blood flow to the ovary?

A. Cardinal ligament
B. Fallopian tube
C. Round ligament
D. Suspensory ligament
E. Ureter

D. Suspensory ligament

The suspensory ligaments house the ovarian arteries. Some additional flow arises from uterine arteries as well.

23

A 25yo sex worker presents for follow up of a pap smear which showed high-grade squamous intraepithelial lesion. She was likely exposed to which strain of HPV?

A. L1-3
B. 1, 2
C. 6, 11
D. 8
E. 16, 18

E. 16, 18

The high risk serovars of HPV are 16 & 18 (and 31, 33). These are the ones apt to cause high grade dysplasia or cancer. (6 & 11 are low grade)

24

Which of the following factors poses the largest risk for the development of endometrial cancer?

A. Alcoholism
B. Young age at onset of sexual activity
C. Low fiber diet
D. Multiparity
E. Prolonged unopposed estrogen use

E. Prolonged unopposed estrogen use

Estrogens promote endometrial proliferation. Young age at onset of sexual activity is a risk factor for cervical cancer. Multiparity is protective.

25

A 65yo man presents with back and hip pain with unintentional weight loss. A nodular prostate is palpated and point tenderness on the spine and pelvis are noted. What are his lab values?

A. -PSA, -Ca, -AlkPhos
B. -PSA, -Ca, +AlkPhos
C. +PSA, -Ca, -AlkPhos
D. +PSA, -Ca, +AlkPhos
E. +PSA, +Ca, -AlkPhos

D. +PSA, -Ca, +AlkPhos

This is prostate cancer with bone metastases, which elevate alkaline phosphatase and "sap" serum calcium.

26

A 25yo primigravid woman reports intermittent tearfulness a week after a normal vaginal delivery. Which symptoms would be suggestive of postpartum depression rather than baby blues?

A. Worrying about the infant
B. Feeling tired
C. Feeling irritable
D. Experiencing mood swings
E. Feeling hopeless

E. Feeling hopeless

Watch out for symptoms of flattened affect or indifference, rather than high emotion.

27

A 28yo female presents with agalactorrhea 6 weeks following a delivery. She reports excessive thirst, fatigue, and feeling cold. Labs reveal elevated serum sodium, with urine osmolality of 220. Which of the following would have increased the patient's risk of developing this condition?

A. Abnormalities of the placenta
B. Endometriosis
C. Gestational diabetes
D. Multiple sexual partners
E. Pelvic inflammatory disease

A. Abnormalities of the placenta

This is sheehan's syndrome, which occurs in the context of partum hemorrhage. Abnormlities of the placenta (eg placenta previa, accreta) can promote hemorrhage.

28

A 25yo female has been trying to become pregnant. She presents with severe abdominal pain. Ultrasound shows a mass in the left fallopian tube and a urine pregnancy test is potiive. Previous infection with which organism could have increased her risk of this?

A. Chlamydia trachomatis
B. Escherichia coli
C. Herpes simplex
D. Human papilloma virus
E. Streptococcus agalactiae

A. Chlamydia trachomatis

Pelvic inflammatory disease increases risk of ectopic pregnancy. Gonorrhea and chlamydia are the primary contributors to PID.

29

Where is the hormone responsible for breast milk production synthesized?

A. Adenohypophysis
B. Corpus luteum
C. Hypothalamus
D. Placenta
E. Syncytiotrophoblast

A. Adenohypophysis

Prolactin is an anterior pituitary hormone. Corpus luteum makes hCG, hypothalamus makes oxytocin/vasopressin/tertiaries, placenta makes hPL and progesterone, syncytiotrophoblast makes hCG.

30

A 27yo female presents with fishy vaginal discharge following sexual intercourse. It is thin, grayish, with a pH of 6.0 with clue cells on histology. What is the mechanism of the antibiotic used to treat this?

A. Bind 30S ribosome to prevent aminoacyl-tRNA attachment
B. Inhibits DNA-dependent RNA polymerase
C. Inhibits ergosterol synthesis
D. Inhibits topoisomerase II
E. Interacts with DNA to form toxic metabolites in the bacterial cell

E. Interacts with DNA to form toxic metabolites in the bacterial cell

This is bacterial vaginosis, which is generally caused by Gardnerella vaginalis. Treat it with metronidazole.