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Lifecycles > First Principles and Early Pregnancy - Test 1 > Flashcards

First Principles and Early Pregnancy - Test 1 Flashcards

1
Q

With regards to the HPG axis, state which hormones act on the various gonadal cell types.

A

FSH –> Sertoli cells (male) and Granulosa cells (female)

LH –> Leydig (male) and Theca cells (female)

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2
Q

Which neurons in the CNS are responsible for mediating the negative feedback of the HPG axis?

A

Kiss1 neurons release kisspeptin to upregulate GnRH release from the hypothalamus.

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3
Q

Where does sperm production occur?

A

Seminiferous tubules

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4
Q

What do Sertoli cells make?

A

Anti-mullerian hormone (for sex differentiation)

Inhibin (neg. feedback for HPG axis)

Androgen binding protein (ABP) - concentrates testosterone for spermatogenesis

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5
Q

Is GnRH secreted constitutively, or in a pulsatile fasion?

A

Pulsatile bitch

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6
Q

Name a GnRH analogue that is used to treat prostate cancer. How does it work?

A

Leuprolide is a GnRH receptor agonist that downregulates LH and FSH secretion

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7
Q

At what cell cycle stage are primary oocytes arrested?

A

Prophase I

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8
Q

At what cell cycle stage are secondary oocytes arrested? When do oocytes complete meiosis?

A

Metaphase II. Meiosis is completed after fertilization.

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9
Q

How early in pregnancy can hCG be detected? When does hCG peak?

A

Can be detected as early as 7-10 days after fertilization. Peaks at the end of the first trimester.

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10
Q

Describe the relative potencies of androgens.

A

DHT > Testosterone > Androstendione > DHEA

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11
Q

Describe the relative potencies of the estrogens.

A

E2 (17-beta estradiol) > E1 (estrone) > E3 (estriol)

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12
Q

Describe the relative potencies of the progestens.

A

Progesterone > 17-OH-progesterone

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13
Q

What is the first, rate-limiting step in sex steroid synthesis?

A

Cholesterol –> pregnenolone

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14
Q

Which hormone has higher affinity for sex hormone binding globulin: 17-b-estradiol (E2) or testosterone?

A

Testosterone

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15
Q

Name two selective estrogen receptor modulator (SERM) drugs, their clinical indications, and side-effects.

A

Tamoxifen - used for breast cancer; side effects are increased thrombosis risk

Raloxifene - treats osteoporosis; no side effects listed

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16
Q

What is the MOA of clomphine, its indications for use, and what are its side effects?

A

Partial estrogen receptor agonist

Used to induce ovulation and to treat male infertility

No side effects

17
Q

Name a drug that treats vaginal dryness. What is its MOA?

A

Ospemifene. Partial estrogen receptor agonist at vaginal tissue.

18
Q

Which enzyme converts testosterone –> DHT?

Name a drug that blocks this enzyme and its clinical use.

A

5-alpha-reductase

Finasteride blocks it to treat BPH, male-pattern baldness, and for male-to-female transexuals

19
Q

At what age does spermatogenesis begin?

A

Puberty (~13 yo)

20
Q

Anatomically, where does fertilization occur? What cell stage implants into the uterus?

A

Fertilization happens in the ampulla of the tube. Blastocyst implants.

21
Q

When is fetal blood flow initiated?

A

A week after implantation (implantation happens 7-10 days after fertilization)

22
Q

Define the following:

1st trimester

2nd trimester

3rd trimester

Preterm

Term

Post-term

A

1st trimester is 1-13 weeks gestation

2nd trimester is 14-27 weeks gestation

3rd trimester is 28-40 weeks gestation

Preterm is <37 weeks

Term is 37-42 weeks

Post-term is >42 weeks

23
Q

What is the classic period for teratogenicity?

A

Between 4-10 weeks gestational age

24
Q

What teratogen category are most medications in? What does that mean?

A

Category C. Means that it can’t be ruled out that the drug is not a teratogen but there is no clear evidence that the drug is harmful to fetal development.

25
Q

What category of teratogenicity is considered to have the highest fetal risk? Name four drugs that fall into this category.

A

Category X

Vaproate

Coumadin

Methotrexate

Accutane

26
Q

What are the TORCHeS infections?

A

T = Toxo

O = Other

  • Zika
  • Parvovirus

R = Rubella

C = CMV

H = HSV

e nothing

S = Syphilis

27
Q

Name the noninvasive newborn screening tests and when each can be performed.

A

1st trimester:

Nuchal translucency US (11-14 weeks)

Cell free DNA screening (after 10 weeks)

2nd trimester:

Serum and nuchal translucency tests (integrated screen) - 15-21 weeks

Anatomic ultrasound (18-22 weeks)

28
Q

What diseases are increased nuchal translucency associated with?

A

Trisomies 13, 18, 21, and Turner syndrome

29
Q

Name the invasive fetal screening tests and when they can be performed.

A

Chorionic villous sampling (11-14 weeks)

Amniocentesis (after 16 weeks)

30
Q

Describe the expected relative values expected on a quad screen for Trisomies 18, 21, and neural tube defects.

A
31
Q

What is the DDx for 1st trimester bleeding?

A

Ectopic pregnancy

Threatened or inevitable abortion

Molar pregnancy

Implantation bleeding

Uterine, cervical, or vaginal lesions

Subchorionic or placental hemorrhage

(+ pyelonephritis in real life)

32
Q

These symptoms are classic for…?

Female of reproductive age presents to ED with pelvic pain and vaginal bleeding. Pregnancy test is positive.

A

Ectopic pregnancy

33
Q

What are the treatments for ectopic pregnancy?

A

Medical (must be hemodynamically stable, can’t have kidney or liver disease, must be reliable for follow-up): methotrexate

Surgical: salpingectomy (if in fallopian tube)

34
Q

How do you manage incomplete abortion?

A

Misoprostol (PGE1) or D&C

35
Q

What are the genetic possibilities or molar pregnancies? What abnormal lab findings might you expect in a patient with a molar pregnancy?

A

Empty oocyte fertilized by two sperm.

Normal haploid oocyte fertilized by two sperm.

hCG levels are really high in molar pregnancy.

36
Q

What are the four basic principles of teratogenicity?

A
  1. Time-dependent (4-10 weeks gestation)
  2. There is a specific mechanism that causes the abnormal development
  3. The teratogen has to have access to the developing tissue
  4. Teratogenicity is dose-dependent
37
Q

What four ultrasound findings are suggestive of neural tube defects?

A

Meningocele/myelomeningocele

Anencephaly

Lemon sign

Banana sign

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