Usmle Reproductive Qbank 1

Front 1

16 yo with amenorrhea, never had menses before, but has fully developed secondary sexual characteristics. PE reveals shortened vaginal canal with rudimentary uterus. What is most likely diagnosis?

Back 1

Imperforate hymen or Mullerian duct abnormalities

Primary amenorrhea in a pt with fully developed secondary sexual characteristics suggest the presence of an anatomic defect int he genital tract, such as the two listed above

Fully developed sexual characteristics implies that estrogen and gonadotropin levels are normal (thus, functional ovaries --> NOT turner syndrome)

Front 2

Explain the mechanism of gestational diabetes

Back 2

Human placental lactogen (hPL) increases insulin resistance, stimulates proteolysis and lipolysis, and inhibits gluconeogenesis. Maternal insulin resistance results from increased secretion secretion of hPL, placental growth hormone, estrogens, progesterone, and glucocorticoids

Front 3

Where is a pudendal nerve block anatomically done?

Back 3

Near the tip of the ischial spine.

Doing this block will provide anesthesia to the majority of the perineum; additional blockade of the genitofemoral and ilioinguinal nerves would provide complete perineal and genital anesthesia.

Front 4

Androgens synthesized in pt's ovaries are converted to estradiol in which cell type? by what enzyme?

Back 4

Granulosa cells carrying the aromatase enzyme

Front 5

Minors can consent to treatment for what conditions?

Back 5

Pregnancy, sexually transmitted disease, birth control, and drug or alcohol addiction without parental consent or notification

Front 6

Vast majority of Down syndrome cases occur during nondisjunction during what meiosis phase and what parent?

Back 6

Maternal meiosis I

Hint 6

Front 7

Tumor markers indicating what conditions:
- CEA:
- CA 19-9:
- AFP
- beta-hCG
- DHEA
- CA-125

Back 7

- CEA: colorectal and pancreatic (70%)
- CA 19-9: pancreatic cancer (74%)
- AFP: hepatocellular carcinoma and nonseminomatous testicular germ cell tumors (eg yolk sac tumors)
- beta-hCG: hydatiform moles, choriocarcinoma, gestational trophoblastic tumors
- DHEA: excess production of adrenal androgens, as in adrenal neoplasia
- CA-125: ovarian malignancy (90% with advanced ovarian carcinoma and 50% with earlier stages)`

Front 8

adnexal mass is indicative of what condition?

Back 8

ovarian cancer

(adnexa = stuff associated with uterus - usually fallopian tubes/ovaries)

Front 9

Loss to follow up creates what kind of bias?

Back 9

selection bias

Front 10

uniformly enlarged uterus with normal appearing endometrial tissue within the myometrium indicates what dx?

common sx?

Back 10

adenomyosis

sx: menorrhagia and dysmenorrhea, lower abdominal discomfort

Front 11

Endometriosis MOA and Sx

Back 11

MOA: presence of normal endometrial tissue in abnormal locations (outside the uterus). These ectopic foci of endometrial tissue undergo menstrual type bleeding causing cyclic pelvic pain (dysmenorrhea) due to local inflammation and fibrosis

Front 12

46, XY fetus has normally functioning Leydig cells but total absence of Sertoli cells. What is the expected phenotype?

Back 12

Both female and male internal genitalia and male external genitalia

male internal: epidiymus, vas deferens
male external: penis prostate

Front 13

16 yo girl with pelvic pain described as crampy lower abdominal pain every 28 days that resolves in a day or two. Never had a menstrual period. Normal height and weight, has fully developed secondary sexual characteristics. Rectal exam reveals palpable mass anterior to the rectum. Serum beta hCG is negative.

Most likely diagnosis?

Back 13

Anatomic defect in genital tract: either imperforate hymen or mullerian duct anomaly.

Adolescent girls with undiagnosed imperforate hymen commonly present with cyclic abdominal or pelvic pain and PE findings suggestive of hematocolpos (blood in the vaginal canal) --> marked distention of vagina that can cause back pain and difficulties with defecation and urination

Front 14

Primary oocytes are arrested at what phase?

What about secondary oocytes?

Back 14

Primary: prophase of meiosis I
Secondary: metaphase of meiosis II

Front 15

Strongest risk factor for cervical cancer?

Back 15

Multiple sex partners

Front 16

Name 4 situations in which disclosure of pt information without the consent of the patient is allowable.

Back 16

1) when child, elder, or spousal abuse is suspected
2) when patient has sustained gunshot or stabbing injuries
3) when patient is diagnosed with reportable communicable disease
4) When pt threatens to kill or physically harm someone else during their interaction with the physician and has a reasonable ability to carry out this threat in the near future

Front 17

Testicular tumors are likely to spread to what lympyh node group

Back 17

para-aortic

Front 18

PCOS patient should be treated with what drug? what's the mechanism of this drug?

Back 18

Clomiphene - estrogen receptor modulator that decreases negative feedback inhibition on the hypothalamus by circulating estrogen and thereby increases gonadotropin production.

Front 19

Bacterial vaginosis sx and most common pathogen?

Back 19

sx: vaginal discharge. wet mount preparation shows few leukocytes. application of KOH solution to the discharge yields strong fishy odor; presence of clue cells

Gardnerella vaginalis

Front 20

What is the statistic used to describe different population findings in a case control study design vs a cohort study?

Back 20

case control: odds ratio
cohort: relative risk

an odds ratio can approximate relative risk when the probability of the event of interest is small (<0.1).