Endo-Repro

Front 1

21 alpha hydroxylase deficiency

Back 1

hypotension, decreased cortisol, increased ACTH, increased sex hormones, hyperkalemia--> see female pseudohermaphrodism

Front 2

17 alpha hydroxylase deficiency

Back 2

super high mineralocorticoids

HTN, hypokalemia, decreased sex levels and decreased cortisol

Front 3

11 beta hydroxylase deficiency

Back 3

no cortisol, stimulates an increase in ACTH, so you have a diversion to the androgens--> you see HTN because deoxycorticosterone has mineralocorticoid activity

Front 4

Leuprolide, Goserline and Nafarelin

Back 4

GnRH mimics

Front 5

Ketoconozale

Back 5

prevents steroid synthesis, antifungal, but also used for polycystic ovarian disease to prevent hirsutism

Front 6

Finasteride

Back 6

5 alpha reductase inhibitor, used to prevent conversion of testosterone to DHT, because DHT has a much higher affinity to the testerone receptor

inihibition of this can treat BPH and male pattern baldness

Front 7

Anastrozole

Back 7

Aromatase Inhibitors, used to treat breast cancer caused by increased estrogen synthesis

testerone turns into estrogen in the presence of aromatase in the granulosa cells

Front 8

Flutamide and Cytoproterene

Back 8

these bind to the testerone receptors on the target cells, preventing testosterone or DHT action

used to treat prostate carcinoma

Front 9

Diagnostic for menopause?

Back 9

elevated levels of serum FSH

estrogen synthesis slows, stops in menopause from degenerate ovaries--> no feedback inhibition on FSH

later on, LH increases as well

Front 10

Where does progesterone come from for a baby?

Back 10

1st trimester, hcG stimulates the corpus luteum to keep producing progesterone

2nd and 3rd trimesters: progesterone from placenta
estrogen from the fetal adrenal gland

Front 11

Tell what TRH does

Back 11

Stimulates the release of Prolactin and TSH

Front 12

Tell me what Prolactin does

Back 12

Inhibits GnRH

Dopamine inhibits Prolactin

stimulated by TRH

Front 13

What does FSH do?

Back 13

stimulates aromatase to convert androstendione into estrogen

Front 14

What does LH do?

Back 14

stimulates the theca cells to convert cholesterol into androstendione via desmolase

the androstendione can convert into estrogen with the aromatase in the granulosa cell

Front 15

what is structurally similar to hcG?

Back 15

FSH, LH and TSH

hcG may stimulate the TSH receptor and cause hyperthyroidism

Front 16

What does Hashimoto's thyroiditis look like?

Back 16

Diffuse monocytic infiltrate with lymphocytes and plasma cells; see Hurthle Cells which are follicular epitherlial cells undergoing metaplastic change, they form large oxyphilic cells with granular cytoplasm.

Front 17

What do you use to treat vWF deficiency?

Back 17

in mild cases where there is still some vWF being made, you treat with DDVAP, to induce endothelial cell to release the vWF.

in women, use OCP

Front 18

Functions of the Sertoli Cells

Back 18

Non Germ Cells

secrete Inhibin (to inhibit FSH)
secrete Androgen Binding Protein (to maintain testosterone levels)
Forms the blood testis barrier

Regulate spermatogenesis

Front 19

Spermatogenesis

Back 19

begins at puberty, takes 2 months for complete maturation, occurs in the semiferous tubules

sertoli cells support spermatogenesis

Front 20

Secondary Spermatocyte

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2ndary=2n

Haploid

Primary spermatocyte is Diploid (4n)

Front 21

Where does estrogen come from?

Back 21

the ovary, placenta and blood

estradiol is more potent than estrone> estriol

Front 22

What is the relationship between estrogen and sex hormone binding globulin?

Back 22

estrogen increases the hepatic synthesis of transport proteins

so there is an increase in synthesis of sex hormone binding globulins

Front 23

What is desmolase?

Back 23

LH secretion stimulates the desmolase to convert cholesterol into androstendione in the Theca Cells

Front 24

What maintains lactation?

Back 24

Prolactin (also inhibits GnRH secretions, so no FSH and LH stimulation, and antagonise the actions of LH and FSH on the ovaries)

Front 25

What is the problem in Klinefelter's Syndrome

Back 25

XXY, dysgenesis of seminferous tubules, no inhibin, no feedback inhibition of FSH. Abnormal Leydig formation, leads to increased LH, no testerone, and increased estrogen

Front 26

What is female pseudohermaphrodism?

Back 26

ovaries are present, but external genitalia is virilized, or ambigous. Excessive and inappropriate exposure to androgenic steroids during early gestation.

Congenital Adrenal Hyperplasia or exogenous androgen administration during pregnancy

Front 27

Male pseudohermaphrodite?

Back 27

testes present, but external genitalia is ambigous

androgen insenstivity syndrome (testicular feminization)

Front 28

See high levels of estrogen, testosterone and LH

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Androgen Insensitivity Syndrome

supermodels

46 XY

defect in the androgen receptor. Uterine tubes and uterus are generally absent. Develop testes but they are in the labia majora

Front 29

Penis at 12

Back 29

5 alpha reductase deficiency

Front 30

Preeclampsia

Back 30

hypertension, proteinuria and edema

ecclampsia (seizures)

if this is seen before 20 weeks, suggests a molar pregnancy

may be associated with HELLP (hemolysis, elevated LFTS, and low platelets)

Front 31

What should you give to an ecclamptic woman to treat her symptoms?

Back 31

Magnesium Sulfate and Diazepam

Front 32

Painful bleeding in the 3rd trimester

Back 32

associated with abruptio placenta (premature detachment of placenta from the implantation site)

fetal death, assocaited with DIC

increased risk with smoking, cocaine use and HTN

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Massive bleeding after the delivery?

Back 33

Placenta Accreta

defective decidual layer allows the placenta to attach to myometrium. Predisposition with prior C section or inflammation

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Painless bleeding in ANY trimester

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Placenta Previa-- attachment of placenta to the lower uterine segment-- may occlude the internal os

Front 35

Pain without bleeding in a pregant woman

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Ectopic Pregnancy

suspect with an increased hCG and sudden lower abdominal pain

mistaken for an appendicitis

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polyhydraminos

Back 36

>1.5--2 Liters of amniotic fluid

associated with esophageal/duodenal atresia, causing an inability to swallow amniotic fluid, and with anencephaly

Front 37

Most common of all tumors in females

Back 37

Leiomyoma

benign, smooth muscle tumor, rarely transforms into malignancy

Estrogen Sensitive

peak occurence at 20-40 years of age

may cause bleeding

histologically: whorled patterns of smooth muscle bundles

Front 38

Leiomyosarcoma

Back 38

bulky irregular shaped tumor with areas of necrosis and hemorrhage, typically arizing de novo

increased incidence in blacks

HIGHLY aggresive, with the tendency to recur

may protrude from the cervix and bleed

Front 39

vWF deficiency

Back 39

will have a prolonged bleeding time and a PTT

vWF is part of factor VIII

Front 40

Fetal Hemoglobin

Back 40

alpha 2 and gamma 2

Front 41

How do you treat nephrogenic diabetes insipidus?

Back 41

thiazides

Front 42

What does clostridium look like?

Back 42

Gram negative bacillus

Front 43

Churg Strauss

Back 43

severe asthma, obstructive lung function tests, necrotizing vasculitis, granulomas and vessel infiltration

Front 44

When you have hyperkalemia, what should you think about the pH?

Back 44

metabolic acidosis

Front 45

What hormone levels will you see in polcystic ovarian disease?

Back 45

increased LH, decreased FSH and increased testosterone

Front 46

stromal breast pathologies

Back 46

fibroadenoma and pyllodes tumor

Front 47

phyllodes tumor

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massive tumor, mostly benign but may turn malignant

Front 48

intraductal papilloma

Back 48

most common cause of bloody nipple discharge in women younger than 50

no increased risk for malignancy

Front 49

breast cancer

Back 49

genetic base in less than 10% of cases

1 in 8 lifetime risk
mean age is 64

initial management of breast mass is fine needle aspiration

Front 50

what do mammographys do?

Back 50

screening test for microcalcifications; most often occur in ductal carcinoma in situ and sclerosing adenosis

outer quadrant: axillary nodes
inner quadrant: internal mamillary nodes

Front 51

Breast cancer prognoses

Back 51

Screen for estrogen and progesterone receptor assays

also screen for S phase (above 5% is bad sign)

Front 52

infiltrating ductal carcinoma

Back 52

stellate-shaped scar

this is the worst and most invasive

Front 53

whtat prevents menstrual blood from clotting?

Back 53

plasmin

Front 54

What causes anovulatory Dysfunctional Uterine Bleeding?

Back 54

excess estrogen stimulation relative to progesterone, absent secretory phase of the cycle. Causes endometrial hyperplasia and bleeding

Front 55

Acute endometriosis

Back 55

most often due to group B strep pathogen-- most often due to a bacterial infection following a delivery or miscarriage