GYN

Question 1

primary source of progesterone production in early pregnancy

Answer 1

corpus luteum

The luteal placental shift starts at approximately 7 to 8 weeks gestational age.

By 12 weeks the placenta is the major source of progesterone production.

Question 2

if the corpus luteum is removed before 7 weeks’ gestational age

Answer 2

Early miscarriage occurs

unless the pregnancy is “rescued” with exogenous progesterone.

Question 3

The corpus luteum

Answer 3

The corpus luteum is essential for establishing and maintaining pregnancy.

The corpus luteum secretes progesterone, which is a steroid hormone responsible for the decidualization of the endometrium (its development) and maintenance, respectively.

develops from an ovarian follicle during the luteal phase of the menstrual cycle or estrous cycle,

following the release of a secondary oocyte from the follicle during ovulation.

While the oocyte (later the zygote if fertilization occurs) traverses the Fallopian tube into the uterus, the corpus luteum remains in the ovary.

Question 4

The dominant follicle is selected by

Answer 4

a preferential increase in FSH receptors on its granulosa cells, which maintains the dominant follicle in light of a reduction in circulating FSH levels.

Question 5

An elevated maternal serum α-fetoprotein can be found in all of the following conditions,

Answer 5

Intrauterine demise / fetal maternal hemorrhage

Spina bifida - elevated when the fetus has an open neural tube defect.

Gastroschisis

congenital nephrosis,

multiple pregnancy,

Question 6

Following birth, gonadotropins what happens to fetal gonadotropins

Answer 6

INCRAESE

estrogens and progestins,

The increased concentration of maternal steroids in the fetal circulation results in suppression of fetal gonadotropins due to negative feedback. At birth gonadotropins increase due to falling maternal steroids.

Question 7

The most common cause of precocious puberty in females is

Answer 7

idiopathic.

Question 8

A pseudo gestational sac is

Answer 8

ectopic gestation

and

accumulation of blood in the uterine cavity.

It can be differentiated from a true gestational sac by the double halo sign of a gestational sac.

Question 9

An imperforate hymen usually presents with

Answer 9

primary amenorrhea and a painful mass.

On examination, there is usually a bulging mass at the introitus that expands with Valsalva.

Question 10

Hematometrocolpos is

Answer 10

the buildup of blood in the vagina (colpos) or uterine cavity (metria) from

obstruction in the reproductive tract.

transverse vaginal septum can occur anywhere in the vagina with most occurring in the upper third.

If there is no perforation in the transverse vaginal septum then the patient will present with amenorrhea, pelvic pain, and a mass secondary to the hematometrocolpos.

Question 11

If the female fetus is exposed to androgens during development, it can result in

Answer 11

The baby is 46,XX with ambiguous genitalia.

internal genitalia remain female because there is no müllerian inhibiting substance produced by the fetal ovary.

Question 12

in early pregnancy Human chorionic gonadotropin functions by

Answer 12

rescuing the corpus luteum

The corpus luteum remains necessary for survival of the pregnancy until the placental shift occurs at approximately 9 weeks’ gestational age after which the placenta makes adequate amounts of progesterone to maintain the pregnancy.

Question 13

A 16-year old female with lack of menstruation and lack of development of secondary sexual characteristics is found to be 46,XY. The gonads should be:

Answer 13

The gonads must be removed due to the risk of progressive virilization

and

tumor formation in the intra-abdominal gonads.

The most common tumors are gonadoblastomas and dysgerminomas.

Question 14

Adnexal masses in what age group incr risk of malig

Answer 14

neonatal and post-menopausal

Question 15

Ovarian masses found in women over the age of 45 found for sigmoid surgery should be managed with

Answer 15

hysterectomy and bilateral salpingo-oophorectomy; 2) Complete surgical staging: abdominal/pelvic fluid washings, peritoneal biopsy, appendectomy, lymph node biopsy, and omentectomy.

Question 16

The granulosa cells in the developing follicle form estrogens directly from:

Answer 16

Androgens! that are actively produced in the thecal cells and diffuse in to the granulosa cells where they are aromatized to estrogens. This principle underlies the two-cell mechanism of estrogen synthesis

Question 17

common causes of pubertal delay in fremales

Answer 17

gonadal dysgenesis due to absence or abnormalities in the X chromosome.

infantile secondary sexual characteristics with streak gonads.

Question 18

Complete androgen insensitivity presents with

Answer 18

an absent vagina

normal breast development

absent or scant pubic an axillary hair.

46,XY karyotypes, functional intra-abdominal testes, and sparse or absent pubic and axillary hair. Serum testing will reveal male levels of testosteron

Question 19

Müllerian agenesis

Answer 19

present with an absent vagina

normal secondary sexual characteristics.

the second most common cause of primary amenorrhea in this list.

Eugonadal subjects most commonly have müllerian segmental abnormalities such as a transverse vaginal septum, complete müllerian agenesis, or androgen insensitivity. Patients with müllerian abnormalities will have 46,XX karyotypes with functional ovaries and a normal distribution of female pubic and axillary hair.

Serum testing will show evidence of ovarian function with normal gonadotropins, estrogen and progesterone levels, and female testosterone levels.

Subjects with müllerian abnormalities have an increased frequency of renal and skeletal abnormalities.

Question 20

17 α-hydroxylase deficiency

Answer 20

uncommon

infantile secondary sexual characteristics

primary amenorrhea,

hypertension.

Question 21

46,XX individuals

Answer 21

present uterus, fallopian tubes, cervix, and vagina;

no vagina (like Müllerian agenesis)

Question 22

A 33-year-old woman with primary amenorrhea, normal pubic and axillary hair, and Tanner stage 4 breasts is found to have a blind vaginal pouch. Which of the following tests would be necessary?

Answer 22

This patient most likely has müllerian agenesis and the IVP would be helpful to rule out renal abnorm

Question 23

The granulosa cells in the developing follicle are primarily dependent on which of the following hormones to continue maturation?

Answer 23

FSH

Question 24

the first steroid hormone to increase in normal puberty

Answer 24

DHEAS
androgens include dehydroepiandrosterone

related to onset of adrenarche

Adrenarche usually occurs 2 years before the onset of pubertal changes, but is not felt to be a “trigger” for other pubertal changes.

Question 25

intrauterine pregnancy one expects the serum hCG level to rise by

Answer 25

at least 66% every 48 hours and double every 72 hours.

An ectopic pregnancy can have an abnormal or normal rise in hCG level, but once the hCG goes above the discriminatory zone no gestational sac will be seen in the uterine cavity.

Question 26

The synthesis of estrogen by the placenta depends upon

Answer 26

fetal adrenal production of DHEAS.

The DHEAS can be transported directly to the placenta where it is converted to estrone and estradiol or transported to the liver where it will be 16-hydroxylated.

Once 16-hydroxylated, DHEAS can be converted to estriol by the placenta. The placenta has a large sulfatase activity, which allows it to metabolize sulfated compounds.

Question 27

Meiosis I is completed just before

Answer 27

release of the oocyte.

Question 28

The number of germ cells reaches a maximum number at approximately what age

Answer 28

20 weeks’ gestational age.

rapid expansion of germ cells occurs due to mitosis.

The number of germ cells continues to decrease in the female until they are completely exhausted in the postmenopausal years.