laracrystalo's version from 2016-07-20 20:49

Disorders of Sexual Differentiation

Question Answer
increased FSH, low estrogenturners
needs gonadectomyturners
other name for turnersgonadal dysgenesis
missing kidneymullerian agenesis
normal breast development and axillary/pubic hair, but missing kidneymullein agenesis
normal breast development but no axillary/pubic hairandrogen insensitivity syndrome (testicular feminization)
AIS vs mullerian agenesisincreased T in AIS vs decreased T in mullerian agenesis. decreased axillary/pubic hair in AIS.
defective androgen receptorAIS
eunuchoid shapeklinefelter
barr bodyklinefelter
streak ovariesturner
hirsutism in mom during pregnancyaromatase deficiency
ovotestistrue hermaphrodite
testes in labia majoraandrogen insensitivity
normal appearing female with uterus that ends in blind pouchandrogen insensitivity
ambiguous genitalia until puberty when suddenly become more male5alpha reductase deficiency
anosmiakallman syndrome


Question Answer
what determines male external genitalia?DHT presence
what determines female external genitalia?NO DHT
what determines male internal genitalia?wolfian duct (testosterone production)
what determines female internal genitalia?lack of MIF (no stertoli cells)
what determines testes vs ovaries?Y chromosome SRY gene (TDF)
girls puberty ordergrowth acceleration, thelarche (breasts), pubarche (pubic hair), menarche
boys puberty starts withgrowth of testicles, penile growth, pubarche, facial hair
estrogen initiatesbreast development and bleeding
androgen initiatespubic/axilary hair, clitoris enlargement, acne
what if bone age is within 1 yr of chronological age?puberty has not started yet
what if bone age is > chronological age?puberty started early
if precocious puberty has high basal LH?central (gonadotropin dependent)
if precocious puberty has low basal LH?do GnRH test
if GnRH test shows low LH?gonadotropin independent (peripheral)
if GnRH test shows high LH?gonadotropin dependent (central)
how to tx central precocious puberty?high dose leuprolide
what to do with peripheral precocious puberty?US of ovaries, gonads, adrenals to see if cyst, tumor, or CAH if all negative


Question Answer
Q tip test greater than 30 degreesstress
weakened pelvic floorstress
sneeze, cough causes exacerbationstress
decreased external urethral sphincter tonestress
sphincteric insufficiencystress
what kind of tone is decreased in stress?external urethral sphincter
treatments for stress?kegels, pessary, pseudo ephedrine, retrobubic urethroplexy (suspension surgery)
urethral hypermobilitystress
what is hyper mobile in stress?urethra
detrussor overactivity/hyperreflexiaurge
sphincter dysfunctionurge
detrussor instabilityurge
oxybutynin treatsurge
spastic contractions of detrussorurge
nocturnal symptoms urge and overflow
absent detrussor activityoverflow
leaks throughout the dayoverflow
detrussor underactivityoverflow
post void residual volume > 300overflow
common in neuro damage/diabetesoverflow
bethanecol can helpoverflow
can be caused by epidural anesthesiaoverflow
urge vs overflow? urge has detrussor overactivity and overflow has detrussor under activity
post part urinary retention cause?long labor, perineal trauma, anesthesia, temporary bladder atony
tx post part urinary retention?ambulation, analgesia, urethral catheterization


Question Answer
painfulHSV, Haemophilus ducreyi (chancroid)
tender lymph nodesHSV, Haemophilus ducreyi, (chancroid)
painlesssyphilis, chlamydia trachomatis (LGV), klebsiella granulomatis (granuloma inguinale)
non tender lymph nodessyphilis
sinus tractschlamydia trachomatis (LGV)
buboeschlamydia trachoma's (LGV)
beefy appearingkelbsiella granulomatis (granuloma inguinale)


Question Answer
treat menopause symptoms?estrogen (lowest dose for shortest time possible)
OCP contraindication?smoker, HTN, hepatic adenoma, migraine with aura
which is less likely to cause HIT?LMWH/enoxaparin > UH
increases ovarian cancer risk?BRCA, >30 age of first birth, no breastfeeding
decreases ovarian cancer risk?BSO, OCPs, first birth < 30 yo, breastfeeding, BTL
increases breast cancer risk?HRT, nulliparity, first birth later than 30, ETOH consumption, white, old age, early menarche, later menopause, BRCA (increased estrogen)
what do OCPs do to cancer risk?decrease ovarian (no effect on breast)
contraception in breast cancer?Copper IUD (no hormones allowed bc can proliferate breast tissue)
breast cancer lumpectomy vs mastectomy cut off?> 4cm mastectomy, <4cm lumpectomy
cordlike thickening of breast?fibrocystic change
peau d'orangeinflammatory breast cancer
eczematous nipplepaget disease
red or clear nipple dischargeintraductal papilloma
porcelain white atrophylichen sclerosis
pruritus with porcelain white atrophylichen sclerosis
treatment for lichen sclerosispunch bx to r/o SCC then clobetasol steroid cream
atrophic vaginitisvaginal dryness, pruritus, dysuria, dyspareunia, diminished fat pad, low elasticity and rugae, urinary frequency and infection
treatment for atrophic vaginitisfirst lubricant, then estrogen cream
torsion vs cyst rupturetorsion has more N/V, less bleeding, no inciting event, towards end of cycle. cyst rupture has more bleeding, post sex, mid cycle
what causes post pregnancy amenorrhea?Prolactin inhibiting GnRH
lack of response to progestin withdrawal?functional hypothalamic amenorrhea causing low GnRh, LH, FSH, and estrogen --> increased bone loss
how do you treat acute abnormal bleeding due to anovulatory cycle?high dose estrogen or progesterone, or both. Mainly progesterone.
hormones in primary ovarian failuredecreased estrogen, increased FSH and LH, 3 months of amenorrhea in woman under 40
if OCP causes HTN?d/c and correct the problem
treatment for vaginismus?kegels and gradual dilation for desensitization
menopause levels1 yr no menses. FSH and LH elevated
Turners hormoneshigh FSH
secondary amenorrhea in female athletes due to ?estrogen deficiency
Testicular tumors HCG secreting (HCG SET high)hydatidiform moles, choriocarcinoma, gestational trophoblastic disease, seminoma, endodermal sinus tumor, teratoma
AFP secreting tumors (FETUS YET LIVES)yolk sac tumor, endodermal sinus tumor, teratoma, liver cancer (HCC)
estradiol secreting testicular tumorleydig cell
testosterone secreting tumorleydig cell
tamoxifenSERM for tx adjuvant of breast cancer
what are risks of tamoxifen?endometrial hyperplasia, venous thromboembolism, hot flashes. Give Raloxifine instead!
RaloxifineSERM used for postmenopausal osteoporosis prevention AND prevents breast cancer. NO EFFECT on post menopausal sx. Can worsen VTE


Question Answer
estrogen producinggranulosa cell
beta hCG producingchoriocarcinoma
struma ovariimature teratoma that produces thyroid tissue!
precocious puberty in girls, postmenopausal bleeding in older womengranulose cell tumors
complication of fibromameigs --> ovarian fibroma, ascites, hydrothorax (R sided)
symmetrically enlargedadenomyosis
unilateral enlarged uterusleiomeioma
vaginal bleeding in postmenopausal woman?endometrial cancer until proven otherwise
OCPs increase the risk of...breast, cervical cancers and hepatomas
OCPs decrease the risk of...endometrial and ovarian cancers
nulliparity increases the risk of...endometrial carcinoma
koilocytescervical dysplasia
squamous cells surrounded by clear halokoilocytes --> cervical cancer!
earliest risk factor for cervical cancer?early sexual encounters / "promiscuity"
post-coital bleeding in young female?cervical cancer
most common cause of cervical cancer death?hydronephrosis (invasion through ureters) --> renal failure
DES during pregnancy?clear cell adenocarcinoma of vulva in the baby later in life
bunch of grapes coming out of little girl's vagina?vaginal rhabdomyosarcoma (sarcoma butryoides)
pain with urination, pooping, and sex?endometriosis
# 1 risk factor for endometrial cancerunopposed estrogen (nulliparity, early menstruation, late menopause, no OCPs, smoker)
CA 125ovarian cancer
pain with ovulationmiddleshmurtz
pain with menstruationendometriosis
treatment for fibrocystic change of the breast?remove caffeine from diet
small rubbery mobile mass in breast that increases in size with pregnancyfibroadenoma
bloody nipple dischargeintraductal papilloma (benign)
milky nipple dischargepituitary adenoma
giant breast massphyllodes tumor (benign)
leaf-like extensionphyllodes tumor (benign)
# 1 and 2 risk factors for breast cancer1. previous breast cancer 2. family history (mom sister aunt --> BRCA)
breast cancer that blocks lymphaticsinflammatory (peau d'orange)
breast tumor with central necrosiscomedocarcionoma (subtype of DCIS)
microcalcifications on mammographyDCIS
eczematous patch on nipplepagets disease from DCIS
decreased E-cadherininvasive lobular breast carcinoma
"indian file" orderly row of cellsinvasive lobular breast carcinoma
bilateral breast conditionfibrocystic change
painless testicular masscancer until proven otherwise
where does testicular cancer spread?para-aortic lymph nodes
where does scrotal cancer spread?superficial inguinal lymph nodes
most common testicular tumormixed germ cell tumor (seminoma)
intracytoplasmic rod-shaped crystalsreinke crystals made of testosterone found in leydig cell tumors
tumor causing precocious puberty in boysleydig cell tumor
testicular cancer in an older man?testicular lymphoma
hyperandrogegism in pregnancy?luteoma and theca lutein cysts