Female Reproductive System

Question 1

During the follicular phase, what is the effect of hormones elevated?

Answer 1

FSH and Estrogen are elevated;

FSH acts on granulosa cells-> protein kinase->increases activity of aromatase-> increased Estrogen; inhibin B synthesis

Estrogen-> negative feedback on FSH and LH; increased local sensitivity to FSH

Question 2

During the follicular phase which hormones decrease levels of pituitary reproductive hormones?

Answer 2

Small amounts of oestrogen secreted into blood from granulosa cells-> negative feedback effect on FSH and LH

Inhibin B from granulosa cells-> negative feedback on FSH;

Question 3

During ovulatory phase of menstrual cycle, which hormones are elevated?

Answer 3

LH (10x basal level) and FSH (surge)

[oestrogen rise ++ at the end of follicular phase-> positive feedback]

Question 4

Which hormone is responsible for the synthesis and release of progesterone from the corpus luteum?

Answer 4

LH surge.

Granulosa lutein cells develop LH receptors due to FSH and oestrogen.

Theca lutein cells have LH receptors.

Question 5

Which hormone is synthesised and released by the corpus luteum?

Answer 5

Progesterone.

Metabolic pathways in Granulosa and theca cells altered to synthesise progesterone; - activity of aromatase-> -oestrogen.

Question 6

What hormone is responsible for negative feedback inhibition of LH and thus demise of corpus luteum?

Answer 6

Progesterone.

Corpus luteum disintegrates also because it becomes less responsive to LH.

Question 7

Woman presents to on-gyn with bbt 1 F higher and thick cervical mucus. What phase of the menstrual cycle is she in?

Answer 7

Luteal phase.

Changes are due to effect of progesterone.

Question 8

Woman presents to on-gyn with basal body temp of 1 F higher and thick cervical mucus. What changes are expected in uterus?

Answer 8

Uterine endometrium becomes secretory- to provide nutrition to blastocyst.

Changes are due to the effect of progesterone.

Question 9

Female presents to ob-gyn with amenorrhea. What is the trigger for the onset of menses phase in menstrual cycle?

Answer 9

Lack of gonadal sex steroids.

Question 10

During the follicular phase of menstrual cycle, which hormones are elevated?

Answer 10

FSH slightly elevated;

Estrogen elevated

Question 11

25 yr old woman comes to the fertility clinic. She has irregular menstrual cycle length. What test can you do to measure hormone levels and thus predict time of ovulation?

Answer 11

Urine test.

Estradiol and progesterone are conjugated in the liver-> increases solubility-> excretion in urine.

Progesterone-> pregnanediol->pregnanediol glucouronide.

Estradiol-> estrone/estriol->conjugated

Question 12

23 yr old woman came to the fertility clinic. Her urine test shows low progesterone metabolites and slowly rising oestrogen metabolites. Which phase of the menstrual cycle do these findings characterise?

Answer 12

Early follicular phase.

Question 13

23 yr old woman came to the fertility clinic. Her urine test shows low progesterone metabolites and rapidly rising oestrogen metabolites. Which phase of the menstrual cycle do these findings characterise?

Answer 13

Late follicular phase.

Question 14

24 yr old woman came to the fertility clinic. Her urine test shows elevated progesterone. Which phase of the menstrual cycle do these findings characterise?

Answer 14

Luteal phase.

Question 15

33yr old underwent surgery to remove both her ovaries. What is the predominant type of circulating oestrogen in this woman?

Answer 15

Estrone.

Androgens [from ovary and adrenals] converted to estrone in adipose tissue via aromatase enzyme.

Question 16

23 yr old comes to clinic to procure OCPs. You prescribe OCP containing progesterone and what form of oestrogen?

Answer 16

Estradiol.

Potency of estrogen: estradiol> estrone> estriol.

Question 17

30 yr old came to the fertility clinic. Her urine test shows low levels of progesterone and oestrogen. Which phase of the menstrual cycle do these findings characterise?

Answer 17

Just prior to onset of menses.

Question 18

23 yr old presents to the fertility clinic. She gives h/o 29 day cycles. When is her expected day of ovulation?

Answer 18

Day of Ovulation= length of cycle -14

Length of luteal phase is constant [14]

Length of follicular phase varies and therefore there are long and short cycles.

Question 19

14 yr old presents with amenorrhea. Tests show low GnRH, LH & FSH. What are the possible causes for the amenorrhea?

Answer 19

Amenorrhea is due to hypothalamic dysfunction in Hypothalamic-pituitary axis.

Causes: Kallmanns syndrome, function hypothalamic amenorrhea, prolactinoma (-GnRH), hypothyroidism (-GnRH)

Question 20

14 yr old presents with amenorrhea. Tests show low levels of LH and FSH, elevated GnRH. What are the possible causes?

Answer 20

It is due to pituitary dysfunction of Hypothalamic-pituitary axis.

Question 21

15 yr old obese girl presents with amenorrhea. Tests show elevated LH, DHEA. What Is the possible cause for amenorrhea?

Answer 21

Poly cystic ovarian syndrome.

Elevated androgens->follicular atresia->an ovulation-> amenorrhea.

Question 22

39 year old woman presents with amenorrhea. Tests show elevated FSH and LH, low levels of oestrogen. What is the cause?

Answer 22

Premature ovarian failure. [premature menopause]

Question 23

28 yr old obese patient presents with infertility, amenorrhea, hirsutism and hyperinsulinemia. What do you expect on her labs?

Answer 23

She has polycystic ovarian syndrome.

LH and DHEA elevated.

Low levels of FSH.

Question 24

28 yr olds lab tests show elevated LH, DHEA and low levels of FSH. What clinical features can be expected?

Answer 24

LH and DHEA elevated- androgenisation (hirsutism), androgen induced follicular atresia-> anovulation induced amenorrhea and infertility

Hyperinsulinemia

Elevated estrogen-endometrial hyperplasia with breakthrough bleeding

Question 25

25 yr old is diagnosed with polycystic ovarian syndrome. How is her amenorrhea treated?

Answer 25

Metformin.

Hyperinsulinemia is a key etiological factor.

Question 26

How is a 26 yr old diagnosed with polycystic ovarian syndrome treated for androgenisation?

Answer 26

Spironolactone.

Question 27

26 yr old is diagnosed with polycystic ovarian syndrome. What is the mechanism of selective feedback inhibition of FSH in this patient?

Answer 27

Increased estrone.

Obese patients-> increased extra glandular conversion of androgens to estrogen-> extra glandular estrogen [estrone] selectively suppresses FSH

Question 28

26 yr old presents with amenorrhea, hirsutism, obesity and hyperinsulemia. What is the mechanism for development of elevated androgens in this patient?

Answer 28

She has polycystic ovarian syndrome.

Selective FSH inhibition by high extra glandular estrogen-> suppression of aromatase activity-> decreased conversion of androgen to oestrogen

Question 29

23 yr old woman presents with increased hair growth in the face, upper chest and back. What is the mechanism for these symptoms?

Answer 29

She has hirsutism; Increased androgens.

Face, upper chest and back are sensitive to high levels of androgens.

Question 30

24 yr old woman presents with hair on the upper chest, face, back. What are the conditions that could cause these symptoms?

Answer 30

Adrenal- congenital adrenal hyperplasia

Ovarian- polycystic ovarian syndrome [MCC]

Question 31

22 yr old woman presents with excessive hair on face, upper chest and back. What hormones are elevated?

Answer 31

She has hirsutism.

DHEA, DHEAS, testosterone, androstenedione.

Question 32

22 yr old woman came to fertility clinic. Her urine test shows low progesterone and slowly rising oestrogen. What are the peripheral effects of the hormonal changes?

Answer 32

Elevated oestrogen- endometrial hyperplasia, thinning of cervical mucus to facilitate sperm entry.

Question 33

26 yr old woman came to the fertility clinic. Her urine tests show elevated progesterone. What is the peripheral effect of the hormonal changes?

Answer 33

Progesterone-secretory changes of endometrium to provide nutrition to blastocyst; cervical mucus is thick to prevent entry of sperms; basal body temperature is elevated by 0.5-1 F

Question 34

27 yr old woman came to ob-gyn dept with a + urine pregnancy test. Which hormone is responsible for progesterone synthesis and release prior to implantation?

Answer 34

LH [surge]–> stimulates corpus luteum–> synthesis and release of progesterone.

Question 35

26 yr old came to the ob-gyn dept in her first trimester of pregnancy. Which hormone is responsible for progesterone and estrogen synthesis and release?

Answer 35

hCG [LH like action] on corpus luteum

Question 36

23 yr old woman came to the clinic in her 2nd trimester. What is the source of progesterone and oestrogen in this phase?

Answer 36

Placenta;

LDL cholesterol-> placenta= progesterone

Fetal adrenal cortex and liver-> androgens to placenta= oestrogen in maternal circulation [estriol]

Question 37

25 yr old woman came to the ob-gyn dept in her 1st month of pregnancy with bleeding from her vagina. What test can be done to assess corpus luteum function?

Answer 37

Urine progesterone; since only corpus luteum synthesises and releases progesterone

Question 38

27 yr old woman comes to the ob-gyn dept in her 3rd trimester with bleeding. What test can be done to asses placental function?

Answer 38

Urine estriol and hCS

Question 39

23 yr old woman comes to the ob-gyn in her 2nd month of pregnancy with bleeding. Urine progesterone level is low. What is the line of treatment in this patient?

Answer 39

Low levels of progesterone till 2nd month indicates premature disintegration of corpus luteum–> termination of pregnancy.

Exogenous progesterone can be administered.

Question 40

22 yr old confirms her pregnancy with a UPT. What hormone does the UPT detect?

Answer 40

Beta subunit of hCG.

[+ for about 3 months]

Question 41

23 yr old woman in her 2 month of pregnancy comes to the ob-gyn dept. who is the stimulation and source of the hormone required to maintain pregnancy?

Answer 41

Stimulation- fetus [hCG]

Source- mother [corpus luteum]

Question 42

23 yr old woman in her 6 month of pregnancy comes to the ob-gyn dept. who is the stimulation and source of the hormone required to maintain pregnancy?

Answer 42

Stimulation- fetus [adrenal cortex and liver send androgens to placenta for estrogen], mother [sends LDL cholesterol for progesterone synthesis]

Source- placenta [fetal and maternal]

Question 43

24 yr old woman in her 3rd trimester is diagnosed with gestational diabetes. What hormone is associated with this condition?

Answer 43

Elevated hPL/ hCS from the placenta

Increases the maternal lipolysis and ketogenesis-> increases glucose availability for fetus

Question 44

23 yr old muslim woman in her 2nd trimester presents with shortness of breath, fruity odour from mouth, vomiting and confusion. She gives h/o of fasting for ramadan. What physiologic changes are responsible for these symptoms?

Answer 44

Hyperinsulinemia and increased peripheral resistance to metabolic effects of insulin.

Question 45

22 yr old woman presents to the ob-gyn ward. Her urine tests show high levels of hCG and slowly rising hPL and PRL. Which week of pregnancy is she approximately in?

Answer 45

About 10th week (end of first trimester)

Question 46

22 yr old woman presents to the ob-gyn ward. Her urine tests show low levels of hCG and rapidly rising hPL and PRL. Which trimester of pregnancy is she in?

Answer 46

2nd trimester.

Question 47

22 yr old woman presents to the ob-gyn ward. Her urine tests show low levels of hCG and peak levels hPL and PRL. Which trimester of pregnancy is she in?

Answer 47

3rd trimester (30-40th week)

Question 48

24 yr old in her third trimester bring the reports of her urine test. Which type of oestrogen will be the highest in the results?

Answer 48

Estriol (produced by placenta)> estradiol> estrone

Question 49

22 yr old female in her 2nd trimester. She is administered thiazide diuretic. Her urine shows glucose ++. What is the physiologic change of pregnancy responsible for this adverse effect of the drug?

Answer 49

Renal threshold for glucose decreases as GFR increases.

Thiazides cause hyperglycaemia.

Question 50

28 yr old is taking OCPs containing estrogen. Which pituitary hormone will be elevated?

Answer 50

Estrogen stimulates lactotrophs to produce prolactin.