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USMLE Reproduction Pathophyisology

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ficks's version from 2018-03-06 03:27

Sexual Developmental Disorders

Question Answer Column 3 Column 4
Klinefelter'sTesticular atrophy-azospermia/eunuchoid (wide hips/gynecomastia)/female distribution of body hair/tall (fusion of epiphyses delayed)/mild mental retardation5Presentation
Klinefelter'sKaryotype 47XXY/single Barr body2Diagnosis
Klinefelter'sFSH up (fibrosis of seminiferous tubules/Sertoli/inhibin lost)/increases aromatase (estriol up/testosterone down)/LH up (estrogen)4Hormones
XYYIncreased height/severe acne/sometimes mild mental retardation/aggressive behavior (higher concentration in prisons)4Presentation
TurnerPrimary amenorrhea/streak gonads/short/normal intelligence4Developmental Sx
TurnerBicuspid AV/preductal Ao coarc/hypothyroid/horseshoe kidney4Nondevelopmental Sx
TurnerXO or XX/XO mosaic/no Barr body in XO cellsN/AKaryotype
TurnerFibrotic ovarian failure decreases estrogen/FSH/LH increase3Hormones
Male pseudohermaphroditismXYN/AKaryotype
Male pseudohermaphroditismTestes/no uterus2Internal genitalia
Male pseudohermaphroditismFemale/ambiguous2External genitalia
Male pseudohermaphroditismAndrogen insensitivity (receptor)/5 alpha reductase deficiency2Etiology
Male pseudohermaphroditismLH/Testosterone/Estrogen all increased3Hormones
Fragile XNormal (CGG repeat expansion)N/AKaryotype
Fragile XMental retardation/MV prolapse/Ao root dilation3Presentation
Fragile XLarge ears/jaw/bilateral macroorchidism3Additional Sx in males
Wolffian ductsMesonephric1AKA
Mullerian ductsParamesonephric1AKA
Wolffian ductsEpididymis/seminal vesicles/vas deferens3Become
Mullerian ductsUpper vagina/cervix/uterus/fallopian tubes4Become
Wolffian ductsFetal testosterone (Leydig)N/AControlling hormone(s)
Mullerian ductsSertoli MIFN/AControlling hormone(s)
ProstateDHTN/AControlling hormone(s)
Phenotypic genitaliaDHT (genitalia female until DHT)N/AControlling hormone(s)
Female pseudohermaphroditismXXN/AKaryotype
Female pseudohermaphroditismOvaries1Internal genitalia
Female pseudohermaphroditismVirilized/ambigious2External genitalia
Female pseudohermaphroditismExcessive androgens early in utero (CAH/exogenous androgens)2Etiology
True hermaphroditism46XX/47XXY mosaic (mixture of cells w/wo Y)N/AKaryotype
True hermaphroditismOvotestis1Internal genitalia
True hermaphroditismAmbigious1External genitalia
5 alpha reductase deficiencyAutosomal recessive1Genetics
KallmanDefective GnRH cell migration/olfactory bulb formation2Pathogenesis
KallmanDecreased GnRH/FSH/LH/Testosterone4Hormones
KallmanAnosmia/lack of secondary sexual characteristics/low sperm count3Presentation
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Dysgenetic Pregnancy Complications

Question Answer Column 3 Column 4
Complete hydatidiform mole46XX/46XYN/AKaryotype
Complete hydatidiform moleRh(D) on trophoblasts/Very high Beta hCGN/AMarker(s)
Complete hydatidiform moleIncreased1Uterine size
Complete hydatidiform mole2 sperm fertilize an empty egg/1 sperm fertilizes and duplicates2Pathogenesis
Complete hydatidiform mole15-20% go on to malignant trophoblastic disease1Benign/malignant
Partial hydatidiform mole69 (XXX/XXY/XYY)N/AKaryotype
Partial hydatidiform moleRh(D) on trophoblasts/normal or high Beta hCG (not diagnostic)N/AMarker(s)
Partial hydatidiform moleNormal1Uterine size
Partial hydatidiform mole2 sperm fertilize a normal egg1Pathogenesis
Partial hydatidiform mole<5% chance1Benign/malignant
ChoriocarcinomaCompication of complete mole1Pathogenesis
ChoriocarcinomaNo villi/syncytio/cytotrophoblasts3Histology
Oligohydramnios<400mL late in pregnancy1Definition
OligohydramniosInability for fetus to excrete urine1Pathogenesis
OligohydramniosPotter's syndrome1Complication
Potter's syndromeUrine failure (absent kidney/cystic kidney/obstructed ureter)/reduced amniotic fluid/hypoplastic lungs (increased thorax pressure)3Pathogenesis
Complete hydatidiform moleHyperemesis gravidarum/preeclamsia <20w/theca-lutein cysts/hyperthyroidism4Presentation
Complete hydatidiform moleCluster of grapes/snowstorm (old)2US appearnce
Polyhydramnios>2000mL in late pregnancy1Definition
PolyhydramniosGestational diabetes/fetal non swallowing (anencephaly/esophageal atresia/tracheoesophageal fistula)4Pathogenesis
All molesRhogam (Ig to Rh(D) on trophoblasts)1Test
ChoriocarcinomaGestational susceptible to chemo (MTX)/nongestational unresponsive2Treatment
ChoriocarcinomaLung>vagina>>>brain/liver/kidney5Metastasis
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Pregnancy Testing

Question Answer Column 3 Column 4
Trisomy 21Up1hCG
Trisomy 21Down1PAPP-A
Trisomy 21Up1NT
Trisomy 18Down1hCG
Trisomy 18Down1PAPP-A
Trisomy 18Up1NT
Trisomy 21Down1AFP
Trisomy 21Down1Urine unconjugated estriol
Trisomy 21Up1Inhibin
Doppler velocimetryUterine/umbilical/fetal middle cerebral3Important arteries
HBVHBsAg1Screen
HBVIntrapartum lamivudine/newborn HBV Ig/HBVaccine3Treat
GBSVaginal culture1Screen
GBSPenicillin intrapartum1Treat
HIV/AIDSELISA/Western/HIV RNA load3Screen
HIV/AIDSZDV intrapartum/newborn or HAART/Caesarian4Treat
RubellaIgG means immune/IgM means active infection2Screen
RubellaPossibly anti rubella Ig1Treat
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Pregnancy Complications

Question Answer Column 3 Column 4
PreeclamsiaTriad of HTN/proteinuria/w/wo edema3Major triad
EclamsiaGrand mal seizures1Presentation
Preeclamsia20w gestation-6w postpartum1Timing
PreeclamsiaDiabetes mellitus/HTN/chronic renal disease/autoimmunities4Predisposing factors
PreeclamsiaBlurred vision/abdominal pain/edema of face-extremities/altered mentation/hyperreflexia/HELLP6Minor symptoms
PreeclamsiaThrombocytopenia/hyperuricemia2Labs
HELLPHemolysis/Elevated Liver enzymes/Low Platelets3Presentation
EclamsiaIV Mg2+/diazepam2Treatment
Placenta increta/accretaEndometrial inflammation/scarring (from C sections)2Predisposing factors
Placenta increta/accretaUsually requires hysterectomy (massive postpartum hemorrhage)1Treatment
Placenta increta/accretaPlacenta invades myometrium1Pathogenesis
Placenta percretaPlacenta invades myometrium to uterine serosa1Pathogenesis
Placenta previaPlacenta implanted to lower uterine segment (maybe over cervical os)1Pathogenesis
Placenta previaPainless bleeding in 3rd trimester1Presentation
Placenta previaPrior C-section1Predisposing factors
Placenta previaUS/NOT pelvic exam2Diagnosis
Placenta previaC section to avoid maternal bleeding1Treatment
Abruptio placentaeRetroplacental clot/premature placental separation2Pathogenesis
Abruptio placentaeHTN/smoking/cocain/previous abruption/older mother (ischemia)5Predisposing factors
Abruptio placentaeUsually 3rd trimester/painful uterine bleeding/tetanic contractions/maybe DIC4Presentation
Abruptio placentaeUS/NOT pelvic exam2Diagnosis
Abruptio placentaeImmediate delivery (high fetal mortality)1Treatment
Ectopic pregnancyAmpulla/ovary/peritoneum/cervix4Locations
Ectopic pregnancyScarring (from salpingitis/PID)>history of prior ectopic/tubal surgery3Predisposing factors
Ectopic pregnancySudden lower abdominal pain (like appendicitis)/adnexal tenderness/uterine bleeding (>6w after LMP)3Presentation
Ectopic pregnancyUS/hCG (must compare to normal/doesn't eliminate appendicitis as possibility)2Diagnosis
PreeclamsiaBed rest/salt restriction/HTN treatment3Treatment
PreeclamsiaPlacental ischemia secondary to lack of trophoblasts invading myometrial spiral arteries1Pathogenesis
Retained placentaMassive postpartum hemorrhage/increases risk for infection1Presentation
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Menopause

Question Answer Column 3 Column 4
Sx of menopauseHirsuitism/Hot flash/Atrophy of Vagina/Osteoporosis/Coronary artery disease/decreased libido/insomnia7HHAVOC(LI)
Premature ovarian failureLoss of function of ovaries <401Definition
Premature ovarian failureAmenorrhea/hypergonadotropism (FSH)/hypoestrogenism3Triad of diagnosis
MenopauseGnRH/FSH/LH up/estrogen down4Hormones
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Pharmacology

Question Answer Column 3 Column 4
LeuprolideGnRH analog (agonist pulsatile/antagonist when continuous by downregulating GnRH receptor)2Mechanism
LeuprolideInfertility1Pulsatile use
LeuprolideProstate cancer/uterine fibroids/precocious puberty3Continuous use
LeuprolideAntiandrogen/nausea/vomiting3Toxicity
Testosterone/methyltestosteroneAgonsit at androgen receptors1Mechanism
Testosterone/methyltestosteroneHypogonadism/promote secondary sex characteristics/anabolism after burn or injury3Use
Testosterone/methyltestosteroneMasculinization in females/reduces intra-testicular testosterone in males (via LH inhibition) causing atrophy/premature epiphysial plate closure/LDL up/HDL down5Toxicity
Finasteride5alpha reductase inhibitor (inh testosterone to DHT)1Mechanism
FinasterideBPH/male pattern baldness2Use
FlutamideNonsteroidal competitive inh of androgen receptor1Mechanism
FlutamideProstate carcinoma1Use
KetoconazoleInhibits steroid synthesis (17/20 desmolase)1Mechanism
SpironolactoneInhibits steroid binding1Mechanism
KetoconazolePCOS to prevent hirsuitism1Use
SpironolactonePCOS to prevent hirsuitism1Use
KetoconazoleGynecomastia/amenorrhea2Toxicity
SpironolactoneGynecomastia/amenorrhea2Toxicity
EstrogensEthinyl estradiol/DES/mestranol3ID
EstrogensBinds estrogen receptors1Mechanism
EstrogensHypogonadism/ovarian failure/menstrual abnormalities/HRT/androgen dependent prostate cancer5Use
EstrogensEndometrial cancer/bleeding postmenopause/clear cell adenocarcinoma in daughters/thrombosis4Toxicity
EstrogensER+ breast cancer/DVT history2Contraindications
ClomipheneSERM/partial estrogen agonist in hypothalamus/prevents feedback inhibition/increases FSH-LH for ovulation3Mechanism
ClomipheneInfertility/PCOS2Use
ClomipheneHot flashes/ovarian enlargement/multiple simultaneous pregnancies/visual disturbances4Toxicity
TamoxifenSERM/estrogen antagonist at breast tissue/agonist in endometria/bone2Mechanism
TamoxifenTreat/prevent ER+ breast cancer1Use
RaloxifeneSERM/estrogen agonist on bone/reduces bone resorption2Mechanism
RaloxifeneOsteoporosis1Use
HRTPostmenopausal symptoms/osteoporosis2Use
ERTIncreased endometrial cancer risk1Toxicity
HRT w/progesteroneCV risk1Toxicity
AnastrozoleAromatase inhibitor1Mechanism
ExemestaneAromatase inhibitor1Mechanism
AnastrozolePostmenopausal breast cancer1Use
ExemestanePostmenopausal breast cancer1Use
ProgestinsBind progesterone receptors/reduce growth/increase vascularization of endometrium3Mechanism
ProgestinsOCT/endometrial cancer/AUB3Use
ProgestinsEdema/depression2Toxicity
Mifepristone (RU-486)Competitive inhibitor at progesterone receptor (partial agonist)1Mechanism
Mifepristone (RU-486)Termination of pregnancy (with misoprostol-PGE1)1Use
Mifepristone (RU-486)Heavy bleeding/GI (nausea/vomiting/anorexia)/abdominal pain3Toxicity
OCTEstrogen/progestins inhibit LH/FSH surge/ovulation1Mechanism
OCT-progestinsThicken cervical mucus to hinder sperm/inhibit endometrial proliferation2Mechanism
OCTSmokers >35 (CV events)/patients with thromboembolic history/stroke/estrogen dependent tumor4Contraindications
RitodrineBeta 2 agonist/relaxes uterus2Mechanism
RitodrineReduces premature uterine contractions1Use
RitodrineNonspecific B1 activation (tachycardia/nervousness/tremors/headache/hyperglycemia/hypokalema/rare pulmonary edema)7Toxicity
TerbutalineBeta 2 agonist/relaxes uterus2Mechanism
TerbutalineReduces premature uterine contractions1Use
TerbutalineNonspecific B1 activation (tachycardia/nervousness/tremors/headache/hyperglycemia/hypokalema/rare pulmonary edema)7Toxicity
TamsulosinAlpha 1 antagonist/inhibits smooth muscle contraction2Mechanism
TamsulosinBPH (alpha 1AD selective>vascular alpha 1B)1Use
SildenafilPDE5 inh/increases cGMP/smooth muscle relaxation in corpus cavernosum3Mechanism
SildenafilED (increase blood flow)1Use
SildenafilHeadache/flushing/dyspepsia/impaired blue-green color vision/hypotension with nitrates5Toxicity
VardenafilPDE5 inh/increases cGMP/smooth muscle relaxation in corpus cavernosum3Mechanism
VardenafilED (increase blood flow)1Use
VardenafilHeadache/flushing/dyspepsia/impaired blue-green color vision/hypotension with nitrates5Toxicity
DanazolSynthetic androgen/partial agonist1Mechanism
DanazolEndometriosis/hereditary angioedema2Use
DanazolWeight gain/edema/acne/hirsutism/masculinization/reduced HDL/hepatotoxic7Toxicity
DinoprostonePGE2 analog/softens cervix/induces contractions2Mechanism
DinoprostoneLabor induction/abortifacient2Use
DinoprostoneGI distress/pospartum DIC2Toxicity
MisoprostolPGE2 analog/softens cervix/induces contractions2Mechanism
MisoprostolLabor induction/abortifacient2Use
LevonorgestrelHigh dose progesterone/inhibits implantation1Mechanism
Levonorgestrelplan B/morning after pill1Use
Mg SulfateCompetes with intracullular Ca2+/reduces uterine tone/contractility2Mechanism
Mg SulfateLabor inhibitor1Use
Mg SulfateFlushing/headache/fatigue3Toxicity
OxytocinUterine myometrial contraction1Mechanism
OxytocinLabor induction1Use
OxytocinHyponatremia/seizures/death (ADH properties)/surarachnoid hemorrhage/uterine rupture5Toxicity
OxytocinFetal distress/prematurity/unfavorable fetal position3Contraindications
NifedipineCa channel blocker/uterine smooth muscle relaxation2Mechanism
NifedipineLabor delayment1Use
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USMLE Reproduction Oncology